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GPs and commissioners lack resources to uphold Francis recommendations, says GPC chair

GPs and CCGs lack the resources to implement the Francis Report recommendations and must challenge their new responsibilities before they are held liable for another Mid Staffordshire style disaster, the chair of the GPC has warned.

Speaking at the British Association of Physicians of Indian Origin conference in Cardiff on Sunday, Dr Chaand Nagpaul said that CCGs are being asked to ‘monitor every commissioning contract on a continuing basis’, yet are expected to do so on a management budget one-third less than PCTs’.

He also said that Robert Francis’s recommendation for GPs to make themselves aware of issues in their local hospitals was ‘not realistic’.

The report into the scandal at the Mid Staffordshire NHS Trust, which found that hundreds of deaths were linked to substandard care at the trust, called on commissioners and GPs to apply a fundamental safety and quality standard in respect to each item of service they commission and ensure ‘enhanced quality standards’ were being upheld by their providers and to monitor contracts on a continuing basis.

But Dr Nagpaul said that these were ‘huge expectations’ that would hold CCGs liable for any future event.

He said: ‘It’s clear that the Francis report has huge expectations of CCGs. As a GP I worry that should we have an unfortunate Mid Staffs event in the future you could see how CCGs could be held liable for their failings in not having actually identified issues in secondary care.  We need to be real. CCGs are fledgling organisations. They have a management budget one third less then their predecessors yet they are already being asked to do so much more.’

Commissioners must make the case now that these are not achievable, he warned. ‘If you think that something is wrong, if you think that something is not achievable, a target, a political imperative is not right you need to challenge it.’

The report failed to mention an increase in resources to support these new roles, Dr Nagpaul added. He said: ‘Crucially, I’ve not seen any mention anywhere of extra resources for CCGs to provide for the Francis recommendations. Do CCGs have the capacity? We have to be realistic.’

‘If this is actually the business of commissioners then you have to do it with more resources. I would implore those CCG board members to actually say that they are not getting these additional resources – you can’t deliver this. There is no point pretending and then if something goes wrong just say “we weren’t able to do it”.’

The GPC chair also warned that CCGs are facing similar pressures to the ‘target culture’ that Mid Staffordshire was operating in to achieve foundation trust status. He said: ‘Look at what CCGs are being asked to do…for the provisions of their quality premium. They embody the same target culture in order to jump through hoops and actually receive resources according to Government priorities.’

GPs’ new responsibilities outlined by the report were also a cause for concern, Dr Nagpaul said. ‘I’m not sure it is possible for us to make it our business and to know what’s going on in hospitals. I’m being realistic – it’s not about being critical of the aspirations.’

Readers' comments (5)

  • Well said! Dr. Nagpaul seems soft spoken but has hit the nail on the head with above statement.
    The government seems to want CCG`s to fail and then blame GP`s and hand it over to private sector.
    CCG heads should all write to the government. Maybe the BMA can take out an ad in the Telly? Newspapers stating the government(s) have cut down beds by 30% and want savings of 20% while we have more people to serve, with more complex diseases, far more expensive drugs and treatments. Earlier we address this the better. People will have to choose between a cheap and cheerful service, co-payments or privatization. People will die! (TM)

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  • Couldn't agree more with anonymous 5:47 p.m. and indeed with the concept advanced by Dr Nagpaul (limits to what expectations we can be expected to deliver whether in GP practices or indeed CCG commissioners, without adequate resources) -- important to get this information into the public domain and indeed our side of the debate in general on many issues not least some facts about our pay and workload, impressing upon the public that increased resources for primary care will not all be channelled into GP pay and are actually required to deliver the service. There has been a very clever campaign running now for almost a decade, no doubt masterminded by the government of the day, to smear GPs in the popular press accusing them of profiteering and not delivering an adequate service. At the very least, the public should hear the other side of the debate, even if the BMA needs to pay to disseminate the message because the media do not want to hear it or publish/broadcast it. The facts: ageing population, increased chronic disease burden, medical inflation of increasing medical advances, tightly constrained NHS budget without any form of copayment permitted, GP and AE recruitment and retention crisis, social care resources also reducing -- the end result, potentially suboptimal medical/social care. Not all GP's fault. Politicians and public need to be involved in this debate and share responsibility for a suitable plan and health service structure enabling provision of an adequate service. Let's not forget, this debate is taking place also in the USA regarding changes to their system -- the challenge in developed nations, how to fund provision of health care that will meet public expectations, is universal. Let's try and stop the politicians always heaping responsibility for the system and it's shortcomings solely on to GP's and have some grown up debate at last,

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  • Agree, the BMA should start the next General Election campaign on the NHS now!!

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  • A 3 star hospital has its staff cut by management to save 1 million. People die. So you hold an inquiry that costs 14 million with 300 recommendations and duty to care. The staff in the NHS care deeply. There just is not enough of them, no matter how many inquiries are held. Failing hospitals and GPs. Who is failing whom?

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  • Although U agree with gist of the article which imakes some excelent points.Regarding previos comment from Anon,8.24pm...stating GP'a re being set up to fail so the Private sector can take over provisien...surly GP are in effect alreadty the priate sector? Most GP' are self employed and charge the NHS for their services ?

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