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The big inheritance

GPs are about to be handed the biggest responsibility for NHS resources since its formation and take on many PCT functions and staff. David Stout of the NHS Confederation sets the scene for the months ahead

GPs are about to be handed the biggest responsibility for NHS resources since its formation and take on many PCT functions and staff. David Stout of the NHS Confederation sets the scene for the months ahead

The Government's white paper – Equity and Excellence: Liberating the NHS – has laid out very ambitious proposals for the health service. Many health observers and commentators have claimed they are the most ambitious proposals in the health service's history.

While previous reforms have been concerned with structure and reshaping organisations without fundamentally changing the nature of power and accountability, these proposals are different. They aim to hand financial power and responsibility to GPs in a way that the NHS has never done before. This is a sizeable feat to achieve by any measure and will require significant organisational and cultural change. Central to the Government's aims is bringing clinicians closer to decisions about how the health service is run and services are commissioned.

While there is broad agreement that this is the right thing to do, there is anxiety about whether the white paper's proposals set out the right way to get us there. The NHS Confederation believes there are a number of potential risks, uncertainties and unexploited opportunities that must be fully considered if the Government's vision is to become a reality.

According to feedback from our members, one of the issues causing most concern is the transition to the new system. Many have worries about possible failures in the quality of care and finances if it is not managed properly, especially given the challenging backdrop of creating £15-20bn in efficiency savings over the next five years.

One of the issues discussed is what primary care trusts (PCTs) do. The NHS Confederation's PCT Network has come up with a substantial list of current PCT functions – over 200 – which has created interest in the media and prompted questions about which functions will be handed over to GP consortia and which will go elsewhere.

Our list doesn't try to suggest who should take responsibility for the functions or which should be dropped, but is meant to act as an aid for early discussions on the establishment of GP-led commissioning. Having a clear idea of what PCTs do now will help to focus minds, but further clarity will be needed before decisions can be taken on what responsibilities can be stopped and which will need to be transferred.

The issue of what PCTs will bequeath is also discussed. One of the main issues of contention for the GP community has been the subject of whether consortia will inherit the debts of PCTs.

While a number of GPs have expressed concern about what kind of starting point this places consortia in, we believe that engaging the GP community early in financial decision-making is critical if we are to have a fully rounded approach to tackling the financial challenges. Now is the time for the GP community to engage in the debate about how best to create savings, not withdraw.

There is strong evidence that PCTs have made good progress in improving their capability as commissioners. And from our own conversations with GPs who have been involved in practice-based commissioning, we know that there is very positive feedback about its merits.

It is imperative that the wealth of experience from commissioning, both managerial and clinical, is not lost and is put to its fullest possible use. There is much invaluable experience in the NHS – we must make sure that we use it wisely in the years ahead as we embark on the biggest change the NHS has seen in its history if it is to be successful.

David Stout is director of the NHS Confederation's PCT Network

The big inheritance The big inheritance

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