Read GP's comments in response to our snap survey on the white paper, and add your views below.
Dr Pam Jones, GP in Christchurch, Dorset
'We did it [management of commissioning budget] as fund holders so we should be capable this time. There need to be fewer of them [PCT's] but we need to have some organisation to support practices in area's such as public health, human resources, IT very much as the Health Authorities did in the 1990's.'
Dr Christine Tarala, GP in Layer de la Haye, Essex
'Don't know [if the government is right to scrap PCT's] it depends on the details. Will they scrap the need to do most of the useless reporting and checking PCT used to do that wasted so much money and increased PCT wages costs by 26% in 2 years?'
Dr Krishna Chaturvedi, GP in Southend, Essex
'There is so much uncertainty about the commissioning, I do not know how GPs will be engaged in this unknown and untested territory. Many of the GP groups who had done fund holding and after success were forced to do PBC, which failed thanks to DoH hierarchy and the PCT quango force, who forced GPs to form clusters and did not engage clinical activities in a professional manner. How it expects GPs now, to do these activities again, I fail to understand.
'We also have a problem in this white paper where there is a lot of information, but no clear guidance as to what would happen to small practices when they are forced to join a consortium. There is no guidelines or definite answers from our leaders, GPC or BMA so maybe it will help if there should be a balloting of grassroot GPs view of this white paper particularly on commissioning, whether we should do full commissioning as the government suggest and we will get the stick from our patients and they will blame us if it fails or we do partly as we know the patient better, what are their clinical needs and have seen the commissioning without too much involvement in management meetings and bureaucracy.'
Dr Robert Leach, GP in Leicester
'All this [the Government plans] is doing is making us responsible for government cuts, I can see the Daily Mail headlines now. And more importantly it's taking clinicians away from doing clinical work.'
Dr Rebecca Mallard Smith, GP in Great Missenden, Buckinghamshire
'In reality, I think we have an enormous challenge ahead of us and no, we are not business managers etc. So we will need to find the appropriate support but we can advise about services our populations need, and support the development of commissioning and providing, and do the job well, I hope! There are many experienced GPs in my area who I have high regard for, and who will be at the forefront of this transition.'
Dr Gary Parkes, GP in Hoddesdon, Hertfordshire
'It won't be 80M it will be <60M and top sliced for management or the new system and heavily regulated and it is a poison chalice. There is no positive vibes in our area about consortia.
'PCTs have never been an efficient model. The government has changed the structure so many times there has never been any time for consolidation. Most of the PCT managers will probably get jobs in the consortia to do commissioning etc. So where is the real change?'
Dr Abadi Dennis, GP in Westminster
'Decent managers (Yes, there are some, especially in Westminster with history and expertise) will be sacked ahead of our requiring their services, and subsequently re-hire them in 2 years time with their agent's fees. There needs to be allowance to allow our GP leaders time reimbursed to allow for clinical leadership to flourish.'
Dr Gurdip Hear, GP in Slough
'The sooner this happens, the sooner we can make things happen for the better for all concerned (patients most of all, of course).'
Dr Alick Munroe, GP in Hounslow
'The BMA needs to define publicly the responsibilities of the NHS and get agreement that government will fund them before accepting the responsibility for operating the purchaser provider split.
'Commissioning consortia need well defined procedures and wider scrutiny to prevent corruption.'
Dr Sara Ritchie, GP in Hackney
'GPs in the UK should be given a vote as to whether we support this white paper, or not.'
Dr Charilaos Minas, GP in Bristol
'Don't know [if GP's can manage budget], a lot depends on the budgets, if we get saddled with pre-existing debts...'
Dr Fiona Clough, GP in Carterton, Oxfordshire
'I do think GPs should be much more involved & that there should be better integration of primary and secondary care, but what they are suggesting is far too much, too suddenly, when our area of expertise is patient care.'
'They should scale down PCTs massively but keep the best people with experience and give GPs much more clout in real decision making without this imposition of commissioning to people who aren't interested in it. To say that commissioning groups have to be huge ie, county wide to be able to cope, is just like re-inventing area health authority's without the experience. To give the groups huge deficits and not try any pilots is asking for failure - it looks as if the government just wants to shift blame quickly.'
Dr Imogen Bloor, GP in London
'Though this is supposedly a consultation, we are led to believe it is 'going to happen, and told we must therefore 'embrace it'.... I am very disappointed that there does not seem to be a serious challenge (from GPs and organisations that represent them) to this almighty change, imposed by a government who as I recall promised there would not be any major re-organisations of the NHS.
'I am also very concerned at the problems posed by removal of practice boundaries and do not feel the logistics have been properly thought out re it's impact on issues such as genuine equity of access, safeguarding, continuity of care, home visits, let alone funding complications and Public Health measures of deprivation for a given practice etc. I fear it benefits young fit mobile working patients at the expense of the chronically sick.'
Dr Sharon Shmueli, GP in Swindon
'This plan has not been thought through as usual and never discussed with the GP's. We have been landed with this white paper that has sent everyone into panic mode. This is something we DO NOT want, we are first line clinicians, not managers. I personally would not want to get involved in these plans and feel rather angry that the government has not thought about asking for our opinions in the first place.'
Dr Ian Rummens, GP in Oswestry, Shropshire
'Proposals are totally unrealistic and impossible to implement in their present form. GPs do not have time or skills to establish or run inadequately resourced and hugely complex administrative machine. Commissioning consortia will fail - with the responsibility laid at GPs door. Is this really the government's agenda - to then be followed by introduction of insurance based/private system of healthcare?'
Dr Rupesh Kumar Jha, GP in Birmingham
'We need more time to be able to do this job, there has to be role for grassroot GPs and no difference between partner and salaried GPs.'
Dr Russell Thorpe, GP in Lytham St Annes, Lancashire
'PBC should not have to cope with; the mess that is the PFI contracts, PCT debt and the cost of dismantling the layers of PCT bureaucracy.'
Dr Adrian Midgley, GP in Exeter
'By taking on the people required, yes [the commissioning budget can be managed] By doing it ourselves, of course not, but why would anyone think the members of the board of directors are actually going to do all the detail themselves.'
Dr Ron Singer, GP in London
'If the government merely wanted to increase GPs' role in commissioning it could have instructed PCTs to organise themselves in such a way as to make this happen. There has to be another reason for the upheaval and extreme plans. In my view this is the full privatisation and de-regulation of the NHS.'
Dr Tim Cantor, GP Locum in Kent
'They [the white paper plans] will not work. I am also worried that these additional responsibilities will distract GPs from providing primary care services for their patients.'
'Although they will probably do a better job than PCTs, GP's task is essentially impossible and they will get the blame when the new arrangements are seen to be a failure.'
Dr Adam Skinner, GP in Kent
'This is going to be a disaster, both for GPs and patients. The PCTs couldn't keep within budget during the years of plenty, there is no way that GPs will manage during the years of famine. There will always be GPs who will welcome the idea of "managing" the NHS, but the vast majority of GPs want to get on with seeing patients. Scrapping PCTs is the equivalent of getting rid of teachers in a school and letting the children run the show. So, no we should be given the responsibility, no we don't have the capability, and the government should have cut each PCT by 50%.'
Dr Mike Gocman, GP in Enfield
'It's ill thought out , rushed and will pose severe pressure on GP's and affect Dr-patient relationship'
Dr D Rapp, GP in Wembley
'GPs can certainly be involved but complete control is too much and not sustainable. They need to work with local hospitals and whatever is left of PCTs.
'Capability and time are the two big issues, to date GPs are too busy and are only getting busier with their clinical work. Inevitably, the private sector will get involved ,and siphon off monies.
'PCTs do much more than commission; I don't know how the Government intends to service all the other things PCTs did up to now.'
Dr David Roberts, GP in Cambridgeshire
'I am sure we do not want to lose the good skills of good managers; what we really do need is for them to focus on activities that will benefit patient care rather than politically correct directives from central government or SHAs.
"Management teams could form social enterprises to provide services to commissioning consortia (and others - eg medicines management for commissioners and providers alike).'
Dr Mike Fitchett, Tower Hamlets
'We are being set up to fail so the private sector can come in and make money, patient care will most likely decline. Also how can we commission on proposed budgets for this of about 25% of what the PCTs got if even they couldn't manage? – Worrying.'
Dr Susan Stuttard, GP in Leeds
'There should be national guidelines re what is covered by the NHS & not a postcode lottery. Then if a patient has a condition not covered by the NHS eg. requesting cosmetic surgery then they can choose to pay privately. Cut out the bureaucracy of who pays for what eg. when patients live within a practice area but out with the boundaries of their PCT. It should be a NATIONAL health system.
'Patients are currently being made to believe that they have the choice to have any condition treated- anywhere- and that because the GPs will manage the budget, they will be able to fund whatever they want. This is not the case.
'I think the system will bring potential conflict of interest between GPs & patients.'
Dr Martin Shutkever, GP in Pontefract, West Yorkshire
'Some urgent clear guidance on rules etc is necessary to kick-start any new processes.'
Dr Mike McCullagh, GP in Ipswich
'High-cost, low-volume procedures, treatments and cancer drugs need to be commissioned at regional level to allow GPs to then do the high volume low-cost stuff safely and effectively without the distraction of the other stuff over which they have no control and limited understanding (why should we?).'
Dr Stewart Findlay, GP in Bishop Auckland
'There is no alternative to this plan - in a cash limited system those that commit the resources through their referrals and prescribing must take responsibility for financial balance. We are also in a better position than PCTs to know what our patients need and plan services accordingly. PCT managers will still be in place to help us but only if we align those managers now with GP commissioning consortia.'
Dr Mary Hawking, GP in Dunstable, Bedfordshire
'Rational comment is difficult when there are so few details about what is actually involved. Take the problem of both commissioning (what will it include?) and capability of "General Practice" (what is this in this context? Individual GPs or practices? Individual existing consortia? New, possibly imposed, groupings of practices into consortia?)
'Then there is the question of the management allowance to support commissioning: if this will mean a reduction of around 60% from the current PCT funding, and this is spread out over a number of consortia, I cannot see that it could cover the expenses for commissioning (including information gathering and analysis) on a consortium level – even if the consortium covered the whole of the previous PCT population.'
Dr Nicholas Brown, GP in Wirrall
'It is a pity that this [the white paper plans] did not evolve - as was intended - from the PCG days, when there was an army of committed and enthusiastic GPs working alongside health authority staff.
'Many of these enthusiastic GPs are completely disillusioned with commissioning, their pay has been cut, PMS growth money has been removed, they are working harder than ever before chasing targets and dare I say it - incoming GPs are virtually all salaried , often working part time with less and less personal commitment.
'PCTs should be retained in a reduced form and obliged to actively involve GP opinion at all levels rather than the token recognition which currently takes place.'
Dr Peter Smith, GP in Weston-super-Mare
'GPs are going to be struggling to deliver if they do not have sufficient time and support to set up the processes and gain the expertise to do this. It is a last gasp attempt to control health service expenditure. The government wins if we succeed and wins if we fail. Many independent observers predict we will not succeed and it opens the way for wholesale privatisation of the health service. There is nothing at present in this for GPs other than emotional stress, which will come if there have to be major restructuring and system changes to stay on budget. Even if there is a remote possibility of making financial gains, it will be viewed negatively if we are seen to benefit. This white paper links clinical freedom to financial responsibility in a manner that no previous government has ever managed. If this had come from Tony Blair's think tank after the previous change in administration, no one would have been surprised.'
Dr Krishna Korlipara, GP in Bolton
'I absolutely support government plans to scrap PCTs, which created huge bureaucracy and enormous waste of public funds at the expense of patient care. GPs were quite used to manage their practice budgets under fund holding plans very well. The only difference now is that practices have to come together to manage their clinical priorities and their budgets collaboratively. They have done that too for our-of-hours care through GP co-operatives. Let no one undermine the confidence in their own ability to manage their practices and their budgets effectively and enhance patient care. Clinicians are best placed to do this.'
Dr Dominique Thompson, GP in Bristol
'We can't underestimate the work they [the PCTs] do, and we need to look at their functions now, and not replicate the work multiple times in the new organisations.'
Dr Mary Hawking
