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At the heart of general practice since 1960

Lansley to give patients power over GP commissioning

By Ian Quinn

Health secretary Andrew Lansley has revealed plans for a massive revamp of the choice agenda which will make it compulsory for all GPs to commission services based on the wishes of individual patients and make it much easier for patients to switch practices.

Speaking shortly before the launch of the Government's health White Paper, due for publication later today, the Conservative health secretary said that although he plans to give GP federations responsibility for handling the NHS' £80bn commissioning budget the key aim of the changes was to give more power to each patient.

The health secretary said scrapping practices boundaries and giving patients more power to choose which GP they see would enable a raft of ambitious changes to the choice agenda.

Under his plans, detailed information about the performance of hospitals in a range of diseases and illness areas will have to be made available to patients by practices, in a much more comprehensive form of the existing Choose and Book, which has been widely ignored by many GPs.

As well as choosing which hospital they go to, patients will also be able to decide which consultant they see with all GPs expected to take on responsibility for commissioning their services.

Mr Lansley told the BBC's Andrew Marr show: ‘There is a responsibility on GPs. GPs are amongst our most senior public service professionals, they do have very great skills. And there is good evidence around the world that physician-led commissioning enables as well as the evidence we've had in this country. Physician-led commissioning enables them to set priorities. Your GP, along with you, is going to be responsible for your care.'

The health secretary has indicated that the funding available to GP federations, via the new independent health board- due to replace SHAs within two years - will be based on a range of health outcomes, including holding GPs to account for cutting mortality amenable to healthcare and premature deaths from heart and lung disease.

Ramping up the NHS market to make the choice of hospital a much more fundamental part of a GP's role, as well as it being linked to their funding via outcomes, will, claimed Mr Lansley, give much more power to patients.

‘Firstly, they will exercise greater choice of GP,' he said. ‘Through their GP, at the point of which they are being referred for treatment, they will have more choice through their GP and it won't be something that's constantly being taken away from them by an unaccountable bureaucracy.

‘Patients will take more control over their own care,' he added. ‘If you said to me, in the reforms that we are making, what will make the biggest difference, I think the biggest difference will be the information that patients have and the control they have as a consequence of that. Because internationally, compared to other countries, patients have much less information about the services available, the choice available. ‘

Mr Lansley said that GPs would also be expected to manage patients' expectations by understanding the limits on NHS resources in their commissioning role.

‘At the moment, as an analogy, GPs are taking the trolley loaded with goods to the checkout, and the PCT is standing there at the checkout with a credit card, saying, ‘I don't want this and I don't want that'.

‘Any healthcare system anywhere in the world, what is essential to make it work better is people who have the lead responsibly for managing the care of patients also understand the constraints on resources.‘

‘I talk to hundreds of GPs across the country, and I know that many of them say, my job is to look after the patient in-front of me. I'm professionally trained to diagnose and treat. But when they say to me, this PCT and SHA get in the way of us making decisions. So, it's not about individual GPs turning into individual managers, it's about them, collectively, making the decisions about the services provided. Frankly, it's about giving patients, through their GP, the opportunity to do this.'

Key elements expected in the white paper include:

• GPs to take on compulsory responsibility for commissioning the £80bn NHS budget, with GPs federations (between 300-500 accross England) expected to contract directly with a new independent health board

• England's 150 Primary care trusts could be scrapped altogether along with strategic health authorities which it has already been announced will be phased out over the next two years

• Patient choice agenda to be ramped up with GPs tasked with giving patients far more information on their choice of treatment using new hospital league tables which will show how they compare in treating of range of diseases and illnesses. Patients will be able to chose which consultant they see

• Local councils to take on major new role in public health measures

• Food Standards Agency to be scrapped as part of plans for £1bn in bureaucracy savings

In a joint statement, Prime Minister David Cameron and his Liberal Democrat deputy, Nick Clegg, said the White Paper ‘combines Conservative thinking on choice and competition with the Liberal Democrat belief in local democracy to create a truly radical vision for the NHS – giving general practitioners authority over commissioning and patients much more control.'

Patients to take charge of their referrals

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