GP consortium chiefs cast doubt on Government's commissioning reforms
By Ian Quinn
Leading GP commissioners have warned MPs the transition to consortia is leading to health inequalities, the closure of hospitals and fears GPs will be handed huge debts.
A group of GPs and NHS executives from areas of the country hailed by the Government for their moves towards GP commissioning also hit out at the unnecessary disruption caused by the reorganisation, which they said was limiting the achievements of practice-based commissioning and failing to reduce bureaucracy, despite massive redundancies among PCT staff.
GPs from a consortium in Hull - the area which came top in last year's World Class Commissioning league table - also told how it had refused to join the Government's pathfinder scheme because it believed it would bring no benefits to patients.
Dr Deborah Colvin, a GP in Hackney, told the health committee the Government's plans could lead to patients in the same street receiving different care because they were covered by different consortia. She also warned that the plans were damaging relationships between GPs and secondary care clinicians, with hospitals increasingly at risk of becoming unviable.
She said the £30m financial crisis facing GPs in Hackney meant there would be a ‘dramatic change in what we can offer patients' and said she ‘could not see' how the situation would not lead to health inequalities.
‘I worry about the PCTs that have big hospitals that have been built by PFI,' she said. 'How are they going to be able to afford to provide the same level of healthcare?'
Dr Colvin told the committee that some hospitals faced closure amid increased competition and GPs slashing referrals.
‘Eventually a hospital is going to be financially unable to continue,' she said. ‘That is the consequence. We have to be honest about where it's going.'
Meanwhile Dr Margaret Lovett, GP commissioning lead for the Hull consortium, an area which came top in the 2009/10 WCC results for commissioning in the country, also attacked the sweeping nature of the changes, including the Government's pathfinder schemes aimed at building critical mass before a 2013 handover from PCTs.
Explaining why her consortium decided not to take part in the pathfinder programme, she said: ‘As a consortium we didn't feel there were any advantages to being a pathfinder. There certainly weren't any advantages to patient care.'
‘The GPs that are leading the consortia are wanting to do it in a very considered fashion. Let somebody else's patients be the guinea pigs.'
Christopher Long, chief executive officer at NHS Hull, added that the mass redundancies brought by the Government's reorganisation had failed to reduce red tape.
‘I'm losing about a quarter of my staff over the next four weeks or so,' he said. ‘It feels like we're getting rid of the bureaucrats but not getting rid of the bureaucracy.'
The committee also heard fears GPs would be saddled with inheriting debts, even in areas where GP commissioning has been most successful.
Dr Peter Weaving, GP commissioning lead for the consortium in Carlisle, where GP commissioning is four years ahead of most of the rest of the country, said it faced taking a £6m debt into next year, leaving GPs with the prospect of starting with major debts unless they were able to root out the causes of long-term overspending.
Dr Weaving admitted that the achievements in Cumbria in bringing down health inequalities would not have been possible without the central funding from the previous Government.
And he warned that unless GPs maintained good relations with their hospital colleagues over commissioning decisions, the acute care system would ‘fall over'.Dr Deborah Colvin: Reforms could exacerbate health inequalities Dr Deborah Colvin: Reforms could exacerbate health inequalities