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Gold, incentives and meh

A journey few GPs will want to take

Are we ‘at the cusp’ of seeing a slump in GP engagement with the NHS reforms?

We are, according to Dr Michelle Drage, chief executive of Londonwide LMCs, ‘at the cusp' of seeing a slump in GP engagement with the NHS reforms.

She is referring not to the grassroots, who are already firmly turned off, but to the one-third with a commissioning role and the one in 10 in leadership positions on clinical commissioning groups. These GPs, whose enthusiasm was essential if health secretary Andrew Lansley's plans were ever to get off the ground, are beginning to be bitten by the same ‘scepticism and demotivation' that some while ago consumed the rest of the profession. Even CCG chairs are increasingly feeling consumed by bureaucracy, frustrated in their ambitions and unnerved by the sheer chaos of Mr Lansley's gigantic NHS restructure.

That chaos has been underlined by a leaked Government policy document: Developing commissioning support – towards service excellence. The title may be bland, and the language laden with managerial jargon, but the thrust is dramatic.

Most of the health service's management functions will first be ‘hosted' by the NHS Commissioning Board as arms-length bodies on commercial terms, and then by 2016 spun off entirely into the unpredictable world of an open market. The NHS can no longer, so the argument goes, afford to run basic management functions such as contracting and tendering inhouse.

The document has split opinion. Some commissioning leaders fear it is an exercise in centralising protectionism, because initially they may be expected to source routine managerial support from the NHS Board. Others, including some who were supporters of Mr Lansley's plans, warn it limits the lifespan of even the pockets of NHS management that will survive the cull of PCTs and SHAs, soon sending them off to swim in the murky waters of commercial competition. How, they ask, will they be able to drive forward commissioning initiatives when the managers assigned to support them are whiling away hours on the Guardian job pages?

But the overriding fear among many GPs is that the new plans represent a smoking gun, exposing Government plans to privatise the health service.

Yes, the document anticipates that for the first couple of years, CCGs will use existing NHS management for their bread-and-butter commissioning support, but even during this period they will be free to buy in specific private services. After that, almost every single management function will be subject to open tender, with no inhouse provision, and existing groups of NHS managers expected to fight for contracts with a range of private companies, all much more experienced in writing the killer commercial bid.

If there was an indication of how radical this document is, it was its ability to finally rouse the BMA, which narrowly voted for all-out opposition to the health bill. BMA chair Dr Hamish Meldrum was apparently unhappy with the change of heart, but he must now fight this wholesale privatisation and insist that where GPs want to, they can continue to rely on NHS managers to support their work.

Otherwise, GP commissioners will be asked to drive forward the health service, but their co-pilots will be the bosses of the commercial sector. Only a handful of hardcore enthusiasts would want to take that journey.

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