Just because GPs are pathfinders doesn’t mean they support commissioning

Soon three quarters of England's GPs will be signed up as commissioning pathfinders, including most of the GPC negotiators, writes Pulse deputy editor Steve Nowottny. It doesn't mean they like the idea

‘It's almost job done.' That's the verdict from Dr James Kingsland, a special adviser on commissioning for the Department of Health, as he yesterday revealed that the launch of a fourth wave of pathfinder GP consortia is imminent.

Within days, pathfinder GPs are expected to cover three quarters of practices in England.

‘This fourth wave is going to mean we've got the vast majority of GPs in England in some kind of arrangement,' he said. ‘The pathfinder scheme has done what it set out to do.'

Job done? Well, maybe. The pathfinder programme has certainly had a surprisingly rapid, and surprisingly smooth, rollout since it was launched last autumn. To have three quarters of the country in a pathfinder group with two clear years to go until GPs take over full responsibility for commissioning is impressive, and keeps pace with what is a very demanding schedule.

But what's much less clear is what this really means for the future of the Government's health reforms. Ever since the first wave of pathfinders was unveiled in December, ministers have hailed the numbers volunteering to sign up as proof of the profession's general enthusiasm for GP commissioning. A press statement entitled ‘Prime Minister congratulates first GP commissioners', for instance, began by describing the numbers signed up as ‘a clear expression of the momentum gathering behind our health reforms'.

In fact, of course, the numbers signing up to be pathfinders are no such thing. A Pulse survey of 450 GPs in March found that among GPs in pathfinders, only 55% support even the principle of GP commissioning – and half said they had no confidence in Mr Lansley.

At the press briefing after the last GPC meeting, it emerged that four of the five GPC negotiators in England are already in pathfinders – and the fifth is keen to join. This does not mean, as the negotiators were keen to point out, that they are wholeheartedly behind the Government's plans, far from it. It is just a reflection of the fact that at a local level practices are organising themselves to ensure they are not left behind, and their local health economy stays as stable as possible with PCTs ‘imploding' around them.

Even our own Jobbing Doctor blogger, who has been splenetically forthright in his criticism of almost every aspect of the Government's plans, is by Mr Cameron and Mr Lansley's logic in the vanguard of the GP commissioning revolution.

The last word though should go to the commenters on our most recent story, who made the point very clearly.

‘We're only in commissioning groups because we've been told we have to be,' said one. ‘Just because passengers got in lifeboats on the Titanic did not mean that they supported the ship sinking,' said another.

Mr Lansley should take note. When it comes to the Government's plans for GP commissioning, many GPs are still far from on board.

Steve Nowottny is the deputy editor of Pulse