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Tories plan to place GPs at core of new NHS market

With the party well ahead in the polls, the prospect of a Conservative Government calling the shots over NHS policy within a few months is becoming ever more likely. At the party conference in Manchester last week, fresh details began to emerge about the party’s plans for primary care, reports By Lilian Anekwe.

By Lilian Anekwe

With the party well ahead in the polls, the prospect of a Conservative Government calling the shots over NHS policy within a few months is becoming ever more likely. At the party conference in Manchester last week, fresh details began to emerge about the party's plans for primary care, reports By Lilian Anekwe.

PAY

Shadow health secretary George Osborne's speech made clear that GPs cannot expect the Tories to loosen the tight grip on GP pay the Government has exerted in recent years. If elected, Mr Osborne will freeze GP pay for a year in 2011, along with over four million pubic sector workers earning £18,000 or more.

It means if the Doctor's and Dentists' Review Body approves the call by current Chancellor Alistair Darling to recommend a pay freeze for senior public sector workers in 2010/11, then GPs could be left reeling from two successive pay freezes. For most GPs, that would mean five freezes in the last six years.

Labour has been accused of relentlessly trying to ‘claw back' GP pay awarded following what many in the party view as botched GMS contract negotiations, but under a Conservative Government there may well still be further claw-backs in store.

The mood at the Tory conference suggested reviewing GP pay is high on the shadow health team's agenda, with a view to correcting what they describe as ‘overly generous' salaries and bringing them back into line with more frugal private sector wages.

One Tory insider speculated ‘£1.5bn could be saved by sorting out primary care alone'.

COMMISSIONING

Handing power for commissioning of primary care services to GPs is one of the jewels in the Conservative health policy crown. Their pledge to ‘devolve decision-making closer to patients' is part of a package of measures shadow health secretary Andrew Lansley promises will ‘shift NHS funds from the back office to doctors and nurses on the frontline'.

For years, commissioning enthusiasts have cited real budgets as the magic ingredient to revitalise practice-based commissioning and recapture the interest of GPs, and that is just what the Tories are promising.

‘We will put GPs in charge of the budgets for their patients' care,' Andrew Lansley says. ‘Family doctors will be responsible for diagnosing, referring and for patients' care all the way through their journey, using their budgets to pay for results.'

But parallels have been drawn between their proposals for GP commissioning and a return to the fundholding. Under fundholding – championed by the last Conservative government in the 1990s - a GP practice managed budgets for practice staff, some hospital referrals, drug costs, community nursing services and management costs.

But to avoid conflicts of interest under its latest plan, the promise of real budgets will have to come with strings attached. Insiders at the conference insisted GPs will not be able to commission services from themselves or ‘unreasonably profit' from any freed-up resources.

OUT OF HOURS

After a series of high-profile failures by out-of-hours providers and a damning report on the current system, the Tories have made the subject a bit of a hobby-horse. GPs opted out of responsibility for out-of-hours as part of the 2004 GMS contract deal and, with a bit of flattery, the Tories hope to talk them into taking it back, at least in the role of commissioners.

‘The solution is putting responsibility back into the hands of GPs. We will return the responsibility for commissioning out of hours back to GPs, as they are the ones that know their patients best', shadow health minister Mark Simmonds says.

The plans may be hard-edged too, with speculation that GPs who refuse to involve themselves in commissioning may lose their contracts under a Tory Government.

But big questions remain about what impact giving power back to GPs would have on the viability of already struggling private providers and for many GPs, the prospect of taking back out-of-hours is the opposite of an election winner.

‘GPs are better placed than the managers in Primary Care Trusts to make the right decisions on behalf of their patients and to manage their care efficiently,' insists Mr Simmonds. ‘Our plan is for local GP commissioning groups to invite tenders, appoint a provider, and then be accountable for delivering a value for money service .'

CHOICE

Under a Conservative Government, choice would be a byword for a major shake-up of the GP contract, with a vow not just to refuse to turn away from Blairite doctrine, but to massively push policies they claim Labour has shied away from.

The Tories promise to do away with practice boundaries and allow commuters to register near their place of work. To avoid destabilising practices in rural areas and commuter belts, they propose differentially funding surgeries in these, largely Tory, areas, and allowing GPs to commission other providers to cover home visits where necessary.

‘Labour have turned their back on patient choice and competition. I will not', Andrew Lansley declares, and patient power ‘will be delivered by incentivising results at every level of the NHS. That starts with the bedrock of the service – family doctors.'

Patients will be able to select a GP practice on the basis of information practices will have to publish about the services they offer, the hours available and the results they achieve.

TARGETS

The Conservatives have already attacked Labour's flagship announcement that GPs will be able to request diagnostic tests for patients diagnosed with cancer – with an eventual target to get the results back within one week. An unworkable central diktat say the party in blue.

The Tories say they will abolish Labour's political targets but look set to replace them with brand new ones.

The one-week diagnostic test rule will go out the window, and in addition to the current two-week referral target for referral to a cancer specialist they aim to make England's one and five-year cancer survival rates ‘at least as good as any in Europe'.

If you add the vow to focus on ‘reduced' mortality following emergency admission to hospital, instead of the current four-hour admission target, and insist on ‘zero tolerance of hospital infections' in preference to the current Government's commitment to cut them by a third, that still looks like a fairly target-drive approach.

QOF

Labours attempts to crank up the number of outcomes measures included in the QOF and shape it to mirror political and public health priorities look to have floundered amid resistance from GPs working for NICE. But a Conservative Government looks set to pick up the baton with even more enthusiasm.

Shadow health minister Mark Simmonds says his party will take a light touch approach in overhauling the QOF, and simply ‘focus on results'. But this is an oblique reference to two Tory buzzwords: outcome measures.

‘We're going to unpick the QOF to make it more focused on outcomes and less on processes, and we do think it would be sensible to pick public health targets like smoking cessation', Mr Simmonds says. Cancer, lung disease, osteoporosis, obesity and arthritis are also high on the list of Tory priorities and GPs will be expected to lead the way.

IT

The Tories are gleefully planning to take a wrecking ball to the National Programme for IT. Labour ministers have championed the Spine – a central database of the records of every patient in the country – in the face of mounting criticism and spiralling costs. But as far as the Tories maintain ‘the spine offers no benefits' and will be scrapped.

In an effort to ‘redress the balance and let patients call the shots', the Tories will allow patients to decide how far they want to opt in and how much of their health records are available for others to see. They would also offer a range of ways to store the records – online on web-based storage systems, by private providers, on smart cards or by their GP.

And GP involvement would not stop there. Shadow health minister Stephen O'Brien says his party will dismantle the central spine in favour of ‘locally held' patient records, held and managed by either the PCT or – you guessed it – GP commissioning groups on behalf of their patients.

Other Tory pledges

GP-led health centres – While the Conservatives do not oppose the principle of GP-led health centres, they argue their deployment should be the decision of local commissioners, and that they should be tailored to the needs of their communities.

Extended hours – The Conservatives will scrap the current Government's extended hours drive as they say it should be up to each GP to decide if they should open from 8am to 8pm, but hope that in urban and commuter areas, GPs will offer patients the choice to see a GP outside of traditional practice hours.

Private providers – Shadow health secretary Andrew Lansley has been openly critical in past of how the tendering process for polyclinics have been loaded in favour of private providers, and would seek to level the playing field between private providers and entrepreneurial GPs.

The Conservatives are keen to correct 'over-generous' GP salaries The Conservatives are keen to correct 'over-generous' GP salaries

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