Gerada hardens RCGP’s stance on white paper

By Gareth Iacobucci

Dr Clare Gerada, who takes over as RCGP chair this week, has signalled an abrupt shift in the college's relationship with the Government by warning she will directly oppose key elements of the NHS white paper.

She told Pulse she had fundamental concerns over elements of health secretary Andrew Lansley's plans and that GPs faced being ‘corralled and de-professionalised' by their new commissioning responsibilities.

Dr Gerada used the interview, conducted days before assuming the college's leadership, to attack plans to hand NICE's rationing role to GPs, dismiss the Government's ‘any willing provider' policy, warn of the consequences of abolishing PCTs and lend her support to Pulse's campaign to prevent GPs from inheriting debts.

Her tough tone contrasted with that of her predecessor, Professor Steve Field, who opted for constructive engagement during his three years in office, and tried to avoid open criticism of government policy.

In a frank interview, Dr Gerada derided the Government's choice agenda as ‘well meaning but misguided', and vowed to fight plans to abolish practice boundaries. She was markedly less effusive than Professor Field about revalidation, warning robust remediation would have to be in place first.

Dr Gerada insisted GPs would ‘rise to the challenge' set by the white paper, but expressed concern about its scale: ‘We've been asking for years to be placed at the centre of decisions, so we're getting what we asked for. There is a saying be careful what you wish for, and I'm concerned about the extent of the white paper; it's a revolution and revolutions are dramatic.

‘The revolution is abolishing PCTs, SHAs, all as we're seeing a 45% cut in management costs. There are only two years to turn the NHS upside down, and an awful lot of things will come out of the woodwork that could put patients and GPs at risk.

‘One of the big unsaid risks is GPs being corralled and de-professionalised. I am concerned GPs will be blamed for over-referring and over-prescribing, and forced to limit prescribing, use referral management centres or not be able to refer to named consultants, or consultants at all, under the guise of demand reduction.'

She warned plans to reduce NICE's role would place GPs in an ‘invidious position': ‘NICE protects us. I am absolutely convinced it needs to be strengthened, not reduced. I'm long enough in the tooth as a GP to have worked pre-NICE, I know what postcode lotteries are about and I'm very concerned.'

She aligned the college's stance on any willing provider with the BMA's, warning: ‘I don't think the idea patients can have any provider, any practice, any hospital is deliverable.'

And on practice boundaries she was defiant, claiming it would bring an end to the registered list: ‘Having patients move from one GP to another creates all sorts of problems. Losing the registered list is something I will work incredibly hard not to allow.'

Dr Gerada said her key priorities aside from the white paper were ‘preserving the generalist, supporting leadership in the next generation and promoting five-year training'.

But on revalidation, one of the college's priorities under Professor Field, Dr Gerada was less than enthusiastic: ‘Let's be clear. Revalidation is important. However, I have concerns that unless we get remediation, we're loading the dice around monitoring, regulation and control rather than support.'

The RCGP has thrown its full weight behind Pulse's A Clean Slate campaign, with its incoming chair insisting it would be a ‘non-starter' to expect GPs to inherit debts from PCTs.

Dr Gerada urged the Government to ‘sort out the mechanics' of the handover, warning that forcing GPs to inherit deficits would create inequalities between consortia.

‘The last thing you want is for GPs to be inheriting debt. I think that's a non-starter,' she said. ‘It's up to the Government to sort out the mechanics. It brought in the white paper and it needs to sort it out.'

Click here to read more about our campaign and lend your support.