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Now the hard work starts

The new government has a chance to make primary care a world leader, but may struggle to persuade GPs that they should take on responsibility for commissioning in their contract, says health policy expert Henry Featherstone

The new government has a chance to make primary care a world leader, but may struggle to persuade GPs that they should take on responsibility for commissioning in their contract, says health policy expert Henry Featherstone



The NHS is sitting quietly in the eye of the storm. The general election and coalition negotiations have passed, the ‘efficiency savings' of at least £20 billion are yet to be realised.

Public expectations will be high because the NHS has been ‘protected' from spending cuts. In a system that has to deliver improved quality with less money both the Conservatives and Liberal Democrats understand that primary care holds many answers for the NHS.

The central thrust of Conservative and Liberal Democrat healthcare policy in recent years has been that we should measure clinical outcomes, rather than political targets.

While the NHS shouldn't expect targets to disappear entirely (they might be re-branded as ‘core standards'), it should expect a hard and fast drive to measuring and publishing clinical outcomes.

It won't be perfect science at first, but it will become increasingly difficult to argue that something that is possible for cardiac surgeons can't be replicated for GPs. There's already ample evidence to show that patient satisfaction correlates well with good clinical care, so in the short term expect more independent patient rating sites like Iwantgreatcare.org to spring up.

Commissioning responsibility is likely to be the main driver of reform. While the Liberal Democrats policy for elected health boards is a sound democratic principle, it lacks the evidence base of the Conservatives policy to hand real budgets and commissioning responsibility to GPs.

Under the previous fundholding model in the 1990s GPs were found to be better than Health Authorities at allocating resources and driving care out of hospitals. There is no reason to suggest that elected health boards will be able to make anything other than short-term political decisions and protect inefficient services.

The problem with GP commissioning, therefore, will be one of implementation. The key question is what will happen to the 40% of sceptical GPs that don't currently want the hassle of holding real budgets?

In the long run they'll probably end up working as salaried employees for organisations that do. Getting nationwide buy-in for GP commissioning will require offering a huge concession to GPs in allowing the sale of ‘GP goodwill', but at the same time a pro-competitive coalition might also encourage large GP practices to enter areas where commissioning uptake is low.

If primary care can transform from a cottage industry into a world leader in patient-centred and preventative healthcare then we know we will have weathered the storm.

Henry Featherstone is head of health and social care at the think-tank Policy Exchange

Health policy and the new government: an analysis

Click here to read a detailed analysis of how the Tory-Lib Dem coalition will affect general practice .

Click here to read a detailed analysis of how the Tory-Lib Dem coalition will affect general practice . Andrew Lansley Henry Featherstone

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