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Draft risk register reveals DH fears over writing commissioning into GP contract

Ministers were warned to expect a tough battle with the GPC over writing commissioning into the GP contract, according to an apparent leak of an early version of the Government's health bill risk register.

The early draft of the register, dated September 2010, outlines a raft of contingency plans for managing the biggest risks associated with the bill.

The document warns implementation of the NHS reforms would be endangered if the Government is ‘unable to negotiate the necessary changes to the GP contract to incentivise and lock practices into consortia', and pledges to ‘develop [a] robust strategy for negotiation'.

Although practices have now being effectively locked into clinical commissioning groups, the document points to future battles over the controversial quality premium, with the Government urgently pushing to incentivise practices to commission differently, but the GPC fiercely opposed to any attempt to tie practice income to CCGs' performance.

The leak of the register to health writer Roy Lilley comes after a protracted battle by Labour ministers and other health bill critics to force publication of the risk register before the bill completed its passage through Parliament. Earlier this month the Government lost an Information Tribunal appeal against a decision instructing it to publish the register, but it has yet to do so.

The early draft of the register published today also pinpoints major risks around finance, loss of staff, and stalled development of new organisations.

Risks identified include:

  • GPs manufacturing an increase in their remuneration by ‘playing the system'
  • Inability to reduce running costs because of consortia numbers
  • Loss of clinical time by GPs due to consortium management responsibilities
  • Failure to manage referral demand
  • Financial instability on balance sheets if GPs successful in reducing hospital admissions
  • Historic deficits being left unmanaged
  • Postcode commissioning
  • QIPP failure especially in areas of changed clinical practice in long term conditions
  • Transition being managed by people who are themselves at risk, with risk of delays, performance dipping and key staff being lost

A Department of Health spokesperson said: ‘We do not comment on leaks. We have always been open about risk and have published all relevant information in the Impact Assessments alongside the Bill.

‘As the latest performance figures show we are dealing with those risks, performance is improving - waiting times are down and mixed sex wards are at an all time low - and we are on course to make the efficiency savings that the NHS needs to safeguard it for the future.'

See the draft risk register here.

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