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King's Fund calls for greater honesty on NHS cuts

By Gareth Iacobucci

The Government must be more honest about the scale of NHS cuts required to survive the financial storm, says the King's Fund.

Their report, Windmill 2009: A response to the financial storm, urges ministers to consider radical proposals to cope with the financial crisis, such as terminating the contracts of GPs who do not reach a certain 'efficiency threshold'.

The report gathered the views of key policy makers, academics, commissioners, and private firms, who were asked to suggest ways of making £15-20bn worth of efficiency savings by 2014.

The authors call for politicians to be more open about the implications of the economic downturn for health spending, but warn the government and regional health bosses not to revert to ‘command and control', and instead foster more leadership roles for local commissioners.

The report also makes a series of ‘no holds barred' suggestions that could potentially be put on the table, which could pave the way for huge changes to way GP services are contracted.

It urges NHS managers to involve staff more in developing solutions for ‘worst case scenarios'. One radical suggestion is that the next Government could consider suspending the contracts of ‘inefficient' GP practices, ‘where quality and productivity fall below minimum thresholds'.

It suggests that future Governments could negotiate a ‘nationally specified efficiency threshold' with the BMA, with no transitional support for affected practices, providing ‘an incentive for small or inefficient practices to seek collaborative arrangements or takeovers'.

The report explained: ‘Currently, PCTs have few levers for weeding out inefficient primary care practices unless the partners in a practice decide to retire. Combined with opportunities for greater competition in primary care, this could drive major improvements in use of resources.'

Other radical suggestions – some of which have already been proposed by the current Government - included scrapping practice boundaries, abolishing primary care trusts and franchising health maintenance and delivery, real budgets for PBC groups, and raising the retirement age.

The King's Fund director of policy, Dr Anna Dixon, said: ‘It is clear that the NHS needs to start planning now and engaging staff and local people as it faces some difficult choices ahead. It's vital that politicians are honest about the level of funding available and support local leaders in making these tough decisions.'

Efficiency savings

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