Dr Michael Dixon, chair of the NHS Alliance and a GP in Cullompton, Devon, looks at what a Conservative-Liberal Democrat coalition might mean for GPs
Clearly the Tories are into a more competitive market-orientated NHS. In particular, they are committed to re-negotiating the GP contract. And I think the Lib Dems will be very much behind them doing that, as they've expressed concerns themselves about it. I think we can expect the Government to be proactive in renegotiating it.
I'm absolutely sure there will be a push towards PBC consortia with hard budgets, but I suspect the effect of a hung parliament will mean they can't be that bullish about it. So they will probably leave a certain amount of leeway as to how GPs can be involved in commissioning.
Apart from the option of being able to hold hard budgets as consortia GPs may alternatively be able to influence PCT commissioning along the lines of previous locality commissioning or PCG-type models, but no GP will be able to hide from taking some responsibility for money and services. So, I don't think everyone will be made to go into hard-budgets in the short-term. It won't be as radical for the majority in terms of having to do it, but radical for those that want to hold budgets as they will now be encouraged and allowed to do so.
They also agree on greater availability of personal general practice. So it is likely, whether by competition or by contract (national or local), that GP practices will have to open for longer hours than at present.
The Tories will want to keep commissioning and provision separate in order to stimulate the market, while the Lib Dems will be more interested in integrating services than extending competition.
But I think both will probably have a re-consideration of Transforming Community Services. It's so much against the grain, particularly against what the Tories are talking up in terms of the importance of primary care, general practice and local responsibility. So I think, there may be a re-jigging of that. Any PCT that's possibly decided to park the community services somewhere temporarily pending the outcome of the election has probably made the right decision.
I think everything will be up for renegotiation in the next 2-3 months. That could be a window of opportunity for general practice if we can start looking at models where general practice and community service can work together rather than being taken over by the acute trust.
As you know, the Tories are committed to a very dramatic reduction in public spending very quickly. The bad news for GPs is that the Tories will probably be tighter on GP pay than the other parties - that has always traditionally been the case. I know some people that say GPs have tended to be worse paid under Tories, but happier because they tend to have a bit more independence.
The other issue is, with their interest in the market, although the pay in terms of GMS and PMS will not go up, the opportunities for the entrepreneurial GP will increase.
Norman Lamb is really quite committed to integration, and if he had to choose would go for integration over competition, and Andrew Lansley would probably got for competition rather than integration. So it would be very interesting to see, especially if they do go for a coalition Government, who holds the secretary of state role, and then to see which of those two principles wins out. I think that will be the big clash.
Dr Michael Dixon Dr Michael Dixon
