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GP leaders ousted following private firm’s report

By Lilian Anekwe

Exclusive: NHS managers are implementing draconian measures against GPs, including forcing local GP leaders to resign from their posts, following the recommendations of a private consultancy firm.

A report by accountancy firm KPMG has set out a series of measures to bring cash-strapped NHS Hillingdon back into the black, including appointing a new PEC chair more willing to drive efficiencies and clamping down on GP referrals.

Since the report was commissioned, Dr Chris Jowett, a GP in West Drayton, Middlesex, has resigned as chair of NHS Hillingdon PEC – for ‘personal reasons', according to the PCT. Dr Sabby Kant, a local GP and former member of the PEC, said the PEC had ‘effectively been dissolved' in response to the report.

Dr Mitcholl Garsin, a GP in Uxbridge, Middlesex, has also quit as chair of Hillingdon PBC group, although he remains chair of Hillingdon LMC.

The trust's referral management scheme is to be scrapped and replaced with tougher management of GP referrals, with balanced scorecards to be used to penalise GPs for ‘inappropriate use of urgent care'.

It is the first of what is likely to be a series of cost-cutting measures introduced on the say-so of private consultants, after Pulse revealed the amount spent by trusts on consultants had tripled in the past two years.

NHS London parachuted in KPMG to audit NHS Hillingdon's finances, and gave the trust just two months to apply the measures ‘to the letter' in return for writing off its £20m deficit.

KPMG's draft report, seen by Pulse, identifies the key reason for the overspend as ‘poor financial controls' by NHS Hilling-don, but concludes that tough management of practices is the best way to balance the books.

‘GPs are not held to account for high referral patterns or inappropriate use of urgent care', the report says, adding the PCT should review and manage primary care contracts ‘for value for money and quality [by] use of the balanced scorecard with incentives for compliance'.

The report warns demand for hospital services is ‘higher than planned' even though the local referral management system successfully cut acute admissions for a range of conditions.

It urges the trust to review referral management and the urgent care centre at Hillingdon hospital ‘as an urgent priority'. Pulse understands six-month termination notices have since been served on both services.

KPMG said the PEC and the PBC group had failed to engage GPs, undermining their ‘ability to influence behaviours'.

The trust is facing a GP rebellion as it advertises for chairs who are prepared to, in KPMG's words, ‘strengthen accountability for GP performance and their impact on PCT budgets'.

All 49 practices in the trust are now threatening to quit PBC.

Dr Garsin, chair of Hillingdon Health, the GP-led provider of the urgent care centre, told Pulse the PCT had made him choose between being PBC chair and LMC chair, because of ‘conflict' between the roles: ‘They are putting all the blame on GPs – it's incredibly unfair.'

A spokesperson for NHS Hillingdon said: ‘It is our duty to put in place cost-effective arrangements.'

How NHS managers have followed report's recommendations

Recommendation: 'Reconstitute the PEC and appoint a chair who is willing and able to take clinical leadership... Consideration should be given to how to reduce the potential risk of role conflicts.'

Action: PBC chair told he could not hold that and LMC role. PEC dissolved, with chair to be replaced.

Recommendation: 'It is suggested the PCT recive its performance management framework to ensure it is aligned to achieving the strategic goals for the PCT through improved clinical service cost-effectiveness.'

Action: Balanced scorecards and referral audits to be used to examine and reduce referrals within practices.

Recommendation: 'GPs are monitored via the balanced scorecard but we understand there to be no consequence of good or poor performance. In the absence of these controls the PCT's ability to influence performance and ultimately its financial position is at risk.'

Action: High referrers to be penalised while high-performing practices are to be given incentives for compliance.

Dr Mitcholl Garsin, a GP in Uxbridge, Middlesex, has quit as chair of Hillingdon PBC group Dr Mitcholl Garsin, a GP in Uxbridge, Middlesex, has quit as chair of Hillingdon PBC group Guest editor

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