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Gerada: Five years to save general practice

Exclusive RCGP chair Dr Clare Gerada has warned there are just five years to save general practice from ‘unravelling' after the NHS reforms go through.

The warning was issued during Pulse's commissioning roundtable debate that took place last week, in which Dr Gerada said she was ‘fearful' that GPs will become too pre-occupied with reducing activity ‘rather than caring' in the new commissioning world.

Dr Gerada issued a rallying call to the senior clinicians at the debate, representing the BMA, NHS Alliance, and NAPC, imploring them to safeguard the future of general practice.

Dr Gerada said: ‘The most important thing to me is general practice. I love it. I've been a GP for 30 years, and I think it is the answer to the health service.'

'We've got about five years, if these reforms go through, before general practice starts to unravel like it has done in other countries.'

‘The numbers coming will decrease, the pay will decrease, our professionalism will decrease, and those around this table are the only people that can protect our profession. Not because it's protectionism, but because it's the right thing – it's what makes the NHS fairer, safer, kinder and cheaper.'

The debate also saw the GPC and RCGP call for a wholesale restructure of clinical commissioning groups, with mergers to ensure giant ‘super-CCGs' cover a population of between one and five million patients – and prevent GPs ‘losing the power to commission independently'.

GPC deputy chair Dr Richard Vautrey said mergers were essential given some large hospital trusts had already been told they would be dealing with commissioning support organisations in future, effectively cutting CCGs out of the loop.

He said: ‘I've already heard large providers talking to the Department of Health. It is saying to them "you will be in conversation with the commissioning support organisations in the future – not with the CCGs but with the support organisations". This is the agenda.'

The new push for ‘super-CCGs' marks a shift in policy for the GPC, which had previously warned CCGs below 500,000 population could struggle to control costs. The GPC said the move was necessary to prevent smaller groups becoming ‘dependant on external support', following the release of controversial Government guidance opening up NHS management to private competition.

The NHS Operating Framework recently gave SHA clusters until March 2012 to resolve ‘any outstanding configuration issues' among the 250-odd CCGs currently established. Last week, the Mid Cornwall and Kernow CCGs in Cornwall announced plans to merge into one CCG covering 464,800 patients, while GPs in Cambridgeshire and Peterborough have backed plans to pursue a single CCG covering 850,000 patients.

Speaking during the debate, Dr Gerada and Dr Vautrey agreed that the announcement of a £25 per head management allowance had made mergers a priority.

Dr Gerada said: ‘One to five million population…is the only way. Then you can start to have population base, you can start to be employing the right people. I think we've got about five years, if these reforms go through, before general practice starts to unravel like it has done in other countries.'

Dr Gerada said only large CCGs would be able to resist farming commissioning support out to the private sector: ‘Otherwise they won't have the economies of scale. You have to have CCGs that are very large.'

At the end of last week GPC chair Dr Laurence Buckman issued a letter to the profession on the GPC's change in policy, revealing negotiators planned to fight for a ‘substantial increase' in the management fee: ‘We do not consider the proposed £25 per head to be sufficient.'

Pulse Roundtable: Debating the NHS reforms

Click here for the full transcript of Pulse's roundtable on the NHS reforms

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