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Greedy GPs? Think again

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I wonder if the British Medical Journal really thought through working with The Times on their joint investigation into CCG commissioning. The resulting front page headline ‘GPs award £2.4bn deals to their own companies’ hardly gets across the nuances of how these contracts are awarded.

It adds further fuel to the myth that GPs are purely motivated by avarice and appears to blame them for the NHS reforms that many in the profession vociferously opposed. In many ways, an own goal.

And these are not ‘groups of family doctors’ as the investigation claimed, in fact the majority of members on CCG boards are not GPs and the constitution of most CCGs means that GPs with a conflict have to step out of the room anyway when any decisions are made about a contract.

I also understand that many of these so-called ‘conflicts’ are merely penny shares in out-of-hours co-operatives and the like. Hardly the ‘free for all’ claimed by The Times.

times

But what is the alternative? A return to the blinkered commissioning of primary care trusts? Goodness, no.

The one solitary success of the (otherwise disastrous) Lansley reforms has been to boost clinical input into the way commissioning decisions are made. We must not forget that those with the most valuable experience to offer CCGs are likely to be those who have more entrepreneurial interests. GPs involved with provider companies will have the insider knowledge that will ensure that patients - rather than process - are at the forefront of any decisions made.

Surely the point is transparency. Perhaps there is a case for GP commissioner conflicts to be more openly declared and the rationale for CCG decisions to be shared more widely. And despite the miserable headline, perhaps the BMJ and The Times can be praised for one thing: highlighting the increasing absurdity of the internal market in the NHS. 

CCG leaders across the country are planning radical changes to GP budgets under co-commissioning, including radical shifts of care into the community. This will see funding shift to GP services and perceived conflicts increase.

The advent of the new GP contract in 2017 is likely to give even more local flexibility to commissioners and the rise of massive super-practices and ‘accountable care organisations’ fusing primary and secondary care – as encouraged by NHS England under the Five Year Forward View – will make a mockery of the purchaser-provider split in the English NHS.

The presence of these ‘mega providers’ will inevitably distort commissioning decisions. It will be become nigh impossible to block accusations of conflicts of interest as most GPs in the area will have some sort of connection with these large entities.

Perhaps the most imaginative solution to this mess is the simplest. Abolish the purchaser-provider split altogether. Some claim that this artificial barrier costs around £5bn to service, valuable money at a time of deep austerity in the health service. There is little evidence that it leads to a more efficient health service and the NHS seems to work pretty well in Scotland without this strange Chinese wall built into the architecture of their health service. Perhaps it is time we took their lead in England as well.

Sweeping away competition and enabling purchasers and providers to work together in the best interests of patient care is surely the best - and perhaps, only - way forward.

Surely even The Times couldn’t have a problem with that?

Nigel Praities is editor of Pulse

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Readers' comments (10)

  • The UK media especially the "newspapers" have a "predatory and immoral" attitude to GPs.
    "Anything for a story" is the policy and the lengths of depravity to create the "story" creates a fantasy world of "Good cowboys and bad". GPs are always wearing the black hat and portrayed as the "evil villains".
    Nothing will change until we get a more professional media culture of actually reporting news rather than disorting news.
    General Practice is a pool of detritus and I would rush to leave the UK-it is only may family and commitments that necessitate my continued "self prostitution" in this toxic environment.

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  • Primary care is essential for the health service . Without it there would be a referral free-for-all . Like the US. Private companies will refer to themselves then you can talk about vested interests. It's all part of the privatisation plan to make GP's the villains . They will be blamed , not the tory politicians or right wing press.

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  • Picture the scene: Gp sits in leather chair stroking white cat. " Good evening Mr.. er ?" The names Hunt . Jeremy Hunt.
    " Goodbye Mr Hunt"

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  • "All Americans are loud" "All English are reserved" "All GPs are greedy" and myriad more generalisations. This is of course nonsense.
    Nonetheless, there is some truth in the The Times' article. The majority of us, the plebs, are working harder for less. But we do have our elite class, the patricians, earning twice or thrice more than David Cameron, following the global tend of "rich getting richer and poor getting poorer."
    (I could name them, but my defence union sat on me -PULSE knows them anyway)

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  • Excellent article - completely on the money. Now if only I could persuade my husband to stop reading this Tory rag.

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  • Vinci Ho

    If you look at the history of this commissioner-provider business (or mess), the terminology changed from any qualified provider (AQP) to any willing provider(AWP) to accountable care organisation (ACO) depending on the temperature of the debate/criticism on the essence of competition/internal market . Deng Xiaoping's famous quote,' Black cat , White cat , whichever managed to catch a rat is a good cat' is probably still true. Bottom line question is WHY do you want competition ? If it is about better quality , involving more people with real time ,frontline experiences is always better than those with the 'tie and black suit'. But what is the government's real agenda ? Is it cheaper the better ? Is it gradually withdrawing the government's commitment on NHS? Yes , like to see more transparency but the problem is you need a government with honesty , which is exactly the one thing missing here ........,

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  • Thanks for the insight
    You are right most of us small practices of 5000 patients
    Get less than £75 per patient and £7000 per session lasting 5 hrs as a partner.
    Some locality leads and retired GPs on CCGs have the bulk of money per patient through providers and we pay for their managers.
    It may be different in our area but do we have named Providers with earnings over £200k pa

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  • I have an issue where GPs are involved in AQP services that they refer to and are profit focused which opens GPs up to accusations of conflicts of interest. We had this issue when PBC started and one of the first consortia emerged out of a provider formed from a group of practices providing services such as endoscopy. I felt at the time that being involved in this sort of arrangement where an organisation were in effect commissioners and providers was un ethical. However the future we are heading towards is integrated care provided by federations possibly in partnership with acute and community trusts. These services are to benefit patients with the aim also of providing efficient care where providers are accountable for outcomes. The fledgling limited company in our area is limited by 'penny' shares with all profit reinvested in patient care. No partners, shareholders or directors will profit from this. what is really happening is that there are groups of GPs giving up their own time to try and change things in the way they feel will benefit the NHS and the patients of our nation.

    i think the Times, Telegraph and Daily Fail need to be shown up as one of the contributory factors in the impending demise of the NHS.. This kind of narrow minded blinkered reporting is not investigative journalism with the aim of protecting 'hardworking family's' it is purely to sell their rags to bigoted individuals who lap up anything that fits their view of the lazy nose-in-the-trough public sector workers.

    The reality is that there are GPs who still feel that by changing things we can help the NHS to survive. The self centred option is not what the press thinks - the self centred option would be to collapse the whole frail system and pick up the pieces as private providers which would be a whole lot worse for the public.

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  • Drachula

    I don't agree these are clinical organisations. Decisions are forced by rules and bureaucracy and fear of litigation. As a result we get downgrading of services in the name of progress, and worse, decisions the CCG says it is taking in my name.
    NOT my name, NOT my decision. Is this a failure of CCGs or of us GPs?

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  • The whole concept of CCGs was that commissioning decisions would be put more into the hands of local clinicians.

    Obviously those local clinicians commissioning the services will come from the same pool as the local clinicians providing the services being commissioned, and so conflict of interests are inherent in the design.

    Not that this is necessarily a problem - it can be overcome with proper systems - but it's hardly a surprise, and not worth a headline!

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