This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

A faulty production line

GPs say NHS reforms have harmed patient care

Exclusive More than twice as many GPs think that the introduction of CCGs has been detrimental to patient care than think have improved it, a Pulse survey has revealed.  

Just over a third (37%) of 592 respondents said care had got worse since the introduction of the Health and Social Care Act - which is an increase on the 32% of GPs who said it had worsened last year - while only 18% said patient care had improved since April 2013.

The survey, which was held in February, also reveals that only a quarter of respondents said that they felt more involved in commissioning decisions since the formation of CCGs than they did under PCTs, with over two-thirds (68%) disagreeing.

The findings strike a blow to the Coalition Government’s reforms, finding that two years on, GPs do not feel the key aims have been achieved.

GP leaders have said that these results show CCG board members that they must ‘face up to pressures facing GP practices’.

But commissioning leaders said that the dissatisfaction had more to do more with a lack of funding in general practice than from CCGs’ actions.

The survey revealed that more GPs felt CCGs had worsened care across the board, including the NHS’s ability to provide care to the most vulnerable, care in the community and variation in treatment.

However, it also found there had been an increase since last year’s survey in the number of GPs who thought patient care had got better, from 13% to 18%.

GPs cited greater rationing of services (such as minor surgery), cuts to crucial community services making it harder to care for patients (such as district nursing) and fragmentation costing more money that could be used for patient care.

Dr Mark McCartney, a GP partner from Cornwall, said that patients were suffering as a result of the changes.

He said: ‘Our politicians and NHS England seem totally detached from the reality of the crisis in the NHS.’

Dr Rachael Kenyon, a GP partner from North Somerset, said the reforms ‘cost a crazy amount of money’.

She added: ‘Projects that PCTs were running and about to implement went by the wayside; these could have significantly improved patient care.’

Dr Marcus Saunders, a GP partner from Portsmouth, said the biggest issue was the ‘shifting of work from a hospital setting to primary care’ with funding following.

He added: ‘The frequency of change and reorganisation means there is no long term plan or corporate memory and diverts time and resources away from patient care. I’m not sure commissioning has enough clout to change this.’

The GPC said that the results ‘were not a surprise’.

Dr Chaand Nagpaul, chair of the GPC, said: ‘This really is a call to CCG board members to face up to pressures facing GP practices, support GP practices and realise that their commissioning plans have little chance of success unless GPs feel supported and understood.’

However, Dr Mike Dixon, chair of the NHS Alliance, emphasised it was ‘crucial’ there continued to be a link between commissioners and local practices.

But he said the declining perception of patient care was unsurprising given the ‘mismatch’ between GP funding and demand for the findings.

He added:  ‘I don’t think it’s to do with the Health and Social Care Act – I think it’s that general practice has lost 25% of its share of NHS funding in the last six or seven years.

‘The incoming government must recognise that we can’t keep on talking about primary care-led NHS and then starve primary care of resources. It’s time for politicians to put their money where their mouth is.’

This comes as NHS England is looking to give CCGs more responsibility fro primary care through ‘co-commissioning’ with NHS England local area teams.

Survey findings

Do you feel more involved in commissioning decisions since the formation of your local CCG, compared with the PCT?

Yes – 26%

No – 68%

Don’t know – 6%


What effect have the NHS reforms and the switch to GP commissioning in April 2013 had on the quality of patient care?

Much better – 2%

Slightly better – 15%

No change – 46%

Slightly worse – 28%

Much worse – 9%


The survey launched on 9 February 2015, collating responses using the SurveyMonkey tool. The 37 questions covered a wide range of GP topics, to avoid selection bias on one issue. The survey was advertised to readers via our website and email newsletter, with a prize draw for a Samsung HD TV as an incentive to complete the survey. Some 592 GPs answered these questions.

Click here for the full survey findings


Readers' comments (8)

  • Not new news. This will not touch the big brothers of UK medicine and so we''ll carry on living and working in a world of nonsense and invested interests.

    Unsuitable or offensive? Report this comment

  • Has anyone surveyed GPs by different CCGs and by their roles in their CCG?
    It could be that some CCGs are working well in the opinion of GPs in the CCG, whereas in other CCGs there are serious problems.
    I'd agree that a sample of 592 might not be large enough to draw any deductions!

    Unsuitable or offensive? Report this comment

  • The only way for GPs to have more control over patient services would be to have a practice budget like the old days of fundholding. Forcing practices into federations will also not be liked by the majority of practices. Unfortunately with the reduction in financial resources and the increasing demand for greater access, higher standards a growing population and more aged patients there would still be a mismatch

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    Fundamentally , one can argue that there is nothing wrong to have more GPs on CCG or PCT boards. But if you do not give people the tools to do their job as well as restricting the freedom how to pick service providers , the whole thing will become a landslide fallacy.,,,,,

    Unsuitable or offensive? Report this comment

  • Just seen a bear having a poop in the woods.

    Unsuitable or offensive? Report this comment

  • To sent out to tender to over 500 units for one item cannot be a proper use of time and money in the NHS But that is what is happening.
    The whole thing is completely bonkers!!!

    Unsuitable or offensive? Report this comment

  • The politicians have discredited the reforms and now also the Profession. Why is are they still in force? Is it that a few Tories supported by the more vainglorious members of our ranks still cling on for reasons best known to themselves?

    Unsuitable or offensive? Report this comment

  • The reforms are still in place because they work!!! Putting GPs in power has given us the real opportunity to be meaningful advocates for our patients, and hold providers to account. I am a recently retired GP CCG Executive member. Our main provider was University of Hospitals of Morecambe Bay NHS FT. You will have read about its many failings. It was only the change from PCT to CCG that enabled us to bring them to book. We did many, many positive things too numerous to mention, and we worked dammed hard to do so, instead of whingeing and carping from the side-lines. Ladies and gentlemen, you get the local system you deserve.

    Unsuitable or offensive? Report this comment

Have your say