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At the heart of general practice since 1960

Trusts allowed 'open cheque book' while GP budgets are dwindling, warns NHS Alliance chief

The current payments system for primary and secondary care is ‘anti-competitive’, allowing trusts ‘an open cheque book’ while GPs are left with a ‘fixed and dwindling budget’, the chair of the NHS Alliance has warned.

Speaking at the organisation’s annual conference in London today, Dr Michael Dixon said that GP commissioners have a ‘year window’ to prove they can reform healthcare, while GPs must embrace the ‘accountable clinician’ model or see their status as professionals diminish as other providers muscle in and take on such roles themselves.

Dr Dixon said that CCGs are hampered by competition regulations.

He said: ‘There will also be the ongoing obstacle of market rules and competition – themselves becoming a new bureaucracy – intimidating commissioners rather than enabling them; obstructing much needed change.’

‘Speaking of competition, perhaps we could start by dismantling an anti-competitive system, which pins down the resources of primary care with a fixed and dwindling budget based on capitation – the same system that offers hospitals an open cheque book and ever increasing proportion of the NHS budget by allowing them to charge for anything that they can persuade anyone to have done to them.’

GP commissioners can help change this system and address problems such as the ‘epidemic of long-term disease’, avoidable deaths and an ‘alienated, stressed, angry, cruel and fragmented society, which itself causes so much long-term disease’, he said.

He added: ‘Time, however, is short. The vultures, waiting to deprive primary care of its new commissioning role, are circling. We have a narrow window of no more than a year in which to show we can make a difference.’

Dr Dixon, who is also a GP in Collumpton, Devon, welcomed the ‘accountable clinician’ model for the care of elderly patients introduced in the GP contract, and urged GPs to embrace the model.

He said: ‘Accountable care organisations may lie at the end of this road for many, but we must continue to ensure good and personal accountable care for patients, and we must also maintain the “small is beautiful” bit of general practice as we extend our role.’

‘Within this lies a solemn health warning for general practice: if we don’t achieve this, and do so within a very short time, then somebody else will. If we don’t choose to become accountable clinicians for our frail elderly, for instance, then other organisations with ambitious plans may decide to supplant rather than support us. “Threat”, they say, “Is an opportunity to evolve” – today, general practice must evolve or die.’

Dr Dixon also described the pressures that GP are under. He said: ‘In the last ten years there has been a 20% reduction in the general practice share of the NHS budget, supported by 40% fewer district nurses. When I started general practice there were three GPs to every consultant. Today there are more consultants than GPs.  Little wonder that a GP partner of mine described herself last week as feeling pulverised.’

Readers' comments (16)

  • Well said!! The government had better watch out all over the country GPs are walking with their feet into retirement oasis, overseas heaven or will go private...just watch us walk right out of the NHS never to return....

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  • Hunt is larging it with Consultants-numbers have spiralled up with no visible corresponding increase in output...but that does not worry the man whose sees his mission statement to persecute GPs who are seen as "the enemy of the state".

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  • You are missing the point.

    Every day there are news stories about the dire financial circumstances of acute Trusts. This is because PbR deliberately underfunds every single medical patient that comes through the front door, in a deluded attempt to close the floodgates.

    This does not detract from the evidence that there is also serious underfunding of general practice, as well as terrible morale everywhere...

    ...but most hospitals are on the brink of complete financial collapse. Hunt has no love for consultants (the feeling is mutual) and there are no open cheque books here.

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  • If all these changes are viewed through the " privatise the NHS " filter all becomes crystal .

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  • Yes its crystal clear.......that we will all be following our colleagues in dentistry very soon, it is absolutely inevitable and ALL parties labour, torys and liberals are to blame.

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  • Anonymous 2.38
    You too are missing the point!
    Trust are going bust due to insane PFI deals for hospital building initially supported by Gordon Brown and continued by the Tories!
    Our children's children will still be paying thes bloated mortgages!!

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  • Yes, the politicians' objective is to blame GPs for the privatization of the NHS. We should never have got involved in CCGs in the first place and it ill- becomes those who advocated them to start issuing warnings.

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  • He said: ‘Accountable care organisations may lie at the end of this road for many, but we must continue to ensure good and personal accountable care for patients, and we must also maintain the “small is beautiful” bit of general practice as we extend our role.’

    Oh yes! This was predictable three years ago rather than what you claim now.

    And are they accountable in the USA? To lawyers only whilst to remain profitable HMOs employ doctors who collude with them to over investigate and over treat patients.

    US healthcare is broken and fundamentally corrupt brought about politicians and their financiers. Same has already started to happen under this Government and the train will arrive sooner rather than later.

    That would be a more salient message from Michael and one that he would be respected for.

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  • 2.38 pm. I support Consultants but the facts are:

    GPs are having Seniority payments abolished, are consultants? No bloody way, Sir! They still enjoy:

    Final Salary Pensions
    Seniority payments
    Clinical Excellence awards
    Distinction awards

    GPs will get **** *** because as we all know they are evil, lazy, cunning and dangerous as peddled by that "cess pit" of hatred The Daily "Society Hating" Mail.

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  • Consultantsare salaried. GPs choose to be self-employed.
    Maybe that is the difference

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