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At the heart of general practice since 1960

RCGP says: 'don't mess with GPs'

Why should GPs believe that a new Conservative government would be a better option than Labour? Cato Pedder joined

Dr Kailash Chand, a GP in Manchester and GPC member, to quiz shadow health secretary Andrew Lansley MP on his plans for primary care and the NHS as a whole

Manifesto spotlight Conservative

As he meets us in the polished atrium of the MPs' office block, Portcullis House, Conservative health spokesman Andrew Lansley is clearly in election mode. Sleek, affable and entirely credible, he is very much on message.

The Conservatives will spend more on primary care and cut red tape, he pledges.

They will safeguard practice-based lists and give GPs more freedom by abolishing strategic health authorities and drastically downsizing PCOs, he promises.

Indeed, it sounds like the Conservatives will implement almost everything GPs have called for in Pulse's manifesto for general practice.

Given the recent criticism of the party for jumping on any available bandwagon, it's hard to avoid feeling that this is all too good to be true.

Lansley claims the Tories' proposals on health are more detailed than any ever produced by an opposition party. And it has pledged to match Labour's £34 billion extra investment in the NHS over the next parliament.

Central to their thinking, Lansley says, is that the 'relationship medicine' that GPs practise is at the heart of the NHS. Patients understand and appreciate what GPs do, he says. But Labour does not.

'That is where a big gap has widened in the last few years.'

He says the Conservatives believe GPs must be given the power to manage their patients. As well as scrapping SHAs and cutting back the functions of PCTs, they would widen practice-based commissioning so that every GP could commission care for their patients and manage their own budgets.

It's impressive rhetoric. But when pushed further, Lansley is short on precision.

For example, he delivers a mixed message on targets and tick-box medicine. Whitehall targets, such as the loathed 48-hour access requirement, will go. But the quality and outcomes framework will stay.

How a new QOF would work is unclear. Lansley says he wants to amend the framework so it is based on 'clinical standards of care' rather than treatment targets.

'We should arrive at the point where GPs are less concerned with specific parameters of things like diabetes. So it's not just about measuring blood sugar levels,' he says. 'Quality needs to be geared to whether you are providing a standard of care that NICE recommends. Less tickbox on conditions, more about meeting standards.'

But he does not indicate how a payments system based on achieving such 'clinical standards' could work.

And if the QOF is to be tailored to NICE guidance, how does that fit with the guidelines overload GPs bemoan?

Lansley says national guidance is needed. Otherwise there is no 'established standard against which patients can judge services and where clinicians can judge what is expected of them,' he says.

Walk-in centres and NHS Direct, two Labour innovations that many GPs believe fragment care and waste resources, will also be retained.

Among Lansley's crowd-pleasing pledges include scrapping Choose and Book and allowing GPs to exception report vaccine dissenters.

On the latter, he says he would ask NICE to assess the clinical and cost effectiveness

of offering single vaccine alternatives to MMR on the NHS. Instead of Choose and Book, GPs would be able to refer any patient to any hospital.

Lansley adds that his 'Right to Choose' policy gives patients a choice of private provider for elective surgery.

Certainly, the march of private providers into the NHS will not be stemmed by the Conservatives. APMS, La-bour's main vehicle for bring companies into primary care, would stay ­ though under plans to reduce the PCT role it would be up to GPs to commission such practices.

GPs can hardly not welcome such an all-encompassing embrace of their demands. But beneath the surface gloss of Andrew Lansley's promises they may be worried at the lack of substance.

Conservative

election pledges

·Provide GPs with

£45 million to open Saturday morning surgeries if they

want to

·An extra £34 billion to be invested in health care over the lifetime

of a Parliament

·Abolish strategic

health authorities and cut back the functions of PCTs

·Scrap Choose and Book and allow GPs

to refer patients to

any hospital

·Scrap Whitehall targets and replace them with clinical standards set by professionals

A GP's verdict: Dr Kailash Chand comments

What strikes me, listening to the election platforms of the political parties, is the overlap.

Labour has invested more money into primary care, and Andrew Lansley also promises more money.

Both parties are offering GP practices the right to commission services.

Mr Lansley's commitments to a list-based GP service at the heart of NHS care are very welcome. GPs would also be delighted if exception reporting was introduced for parents refusing child immunisations.

But looking at single vaccines as an alternative to MMR is not evidence based and a questionable political priority.

Also, the QOF is already based on scientific evidence, so it is difficult to see what Mr Lansley was getting at there.

There is a clear payment system based on clinical standards and every indication that the QOF is delivering better care for patients and more resources for practices.

Caution is needed for any words from a party in opposition, since the actuality if they were in power may be quite different. The current government is testimony to this.

The devil is in the detail ­ there is ambiguity with regards to policy about APMS, self-regulation and GP pensions. The commitment to Saturday morning surgeries may be against the grain of the out-of-hours opt-out.

Also concerns over wider Tory policies are not discussed, such as subsidising patients to take private insurance or part funding private treatments. These may undermine the infrastructure of NHS providers to a greater degree than current government

policy.

Overall 6/10.

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