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.’