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Health bill changes risk repeating mistakes of the past, warns GP leader

The Government's proposed alterations to the Health and Social Care Bill risk repeating the mistakes of the past and alienating grassroots GPs through excessive bureaucracy, GP negotiator Dr Chaand Nagpaul has warned.

Speaking in a panel discussion at the NHS Confederation's annual conference in Manchester, Dr Nagpaul said the fundamental question GPs were asking following the tabled amendments to the bill was 'how will things be different?'.

He said the focus post-pause had to be on winning the buy-in of grassroots GPs in order to give new clinical commissioning groups any chance of meeting 'savage' financial targets, and for the new system to be more than just a rehash of practice-based commissioning (PBC).

But he said the BMA were concerned that changes such as the introduction of clinical senates and the greater powers being handed to the NHS Commissioning Board could have the opposite effect and impede local decision-making.

Dr Nagpaul said clinical commissioning groups could only work ‘with the engagement, buy-in and loyalty of all GPs, and in particular, grassroots GPs in terms of the clinical decisions they make in the consulting room'.

‘This is what will affect the financial performance of a commissioning group. Therefore our focus needs to be on the grassroots and not only on the few who will lead these organisations,' he said.

'I also think we should remember we're not starting with a blank sheet of paper. We ended an era of PBC and if you could just re-wind six years and look at the Government's rhetoric of the day, it was with similar gusto and similar promise to what we are hearing today.'

‘Six years later, whilst there have been some successes, in general PBC failed to engage GPs. So the challenge facing us post-listening is, how will this be different? How will everyday GPs actually engage with an agenda in a manner in which we haven't in the past managed to secure. That is the fundamental question for us.'

Dr Nagpaul added that 'the rhetoric had to be matched by the reality': ''The concerns we have are about re-creating the past. On the one hand we would be told that the NHS would be liberated. Now we've got 15 clinical senates, in London we'll have one for the entire region of London. Our view is that you need to involve clinicians at the right point of commissioning. Our concern is that these senates could end up being structural organisations that could end up impeding local determinations.'

But Future Forum leader Professor Steve Field was more bullish on the post-pause landscape, insisting that the stage was now set for clinicians and managers to 'work together for the greater good'.

He said: 'We have to be light of foot without layers of bureacracy. From talking to David [Nicholson] that's exactly what he has in mind.'

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