CCGs will view cutting spending on referrals and prescribing as ‘a good place to start’ when they tackle the task of finding major efficiency savings, a GPC leader has warned.
Dr Simon Poole predicted ‘a lot of tension’ in the relationship between CCGs and their constituent practices as commissioning groups target general practice as a ‘quick win’ where savings can be found.
‘This is something that really worries me,’ said Dr Poole, deputy chair of the GPC’s commissioning and service development sub-committee. ‘If practices are seen by CCGs just as a point of scrutiny regarding how much they are spending, how much they are referring, how much they are prescribing, it will cause a lot of tension.’
He said CCGs struggling to make savings would have four big options open to them: rationing low priority treatments, renegotiating contracts with hospitals, redesigning care pathways or cutting spending on primary care.
The first two options were difficult to put into practice, while making savings through more efficient care pathways would require imaginative CCGs to work with local practices, Dr Poole told the NAPC Annual Conference in Birmingham – leaving primary care spending as the place many CCGs would look to start.
He urged CCGs to recognise the complex reasons why different practices had different levels of funding and spending. ‘We need to be careful that CCGs don’t make simplistic observations on practices’ spending because historically practices are doing very different things.
‘In my area there are four types of practice: those that treat the worried well, those treating the worried unwell, those who treat the unworried well – mainly students – and those in really deprived areas dealing with the unworried unwell. There are big differences in funding and big differences in spending.’
But he added that a few practices that were genuinely failing would need to be performance managed by the CCG: ‘There are clearly some intolerable levels of variability when we do need to be asking searching questions about what practices are doing. This will bring into stark relief some real challenges for CCGs and their member practices.’
Dr Poole said CCGs may see reducing referrals as a ‘quick win’ but he warned against any schemes that offered GPs incentives to meet arbitrary targets to cut referral rates. ‘We at the BMA have put our foot down on this and said it’s quite unethical,’ he said. ‘It’s just not acceptable – even if they say “we’ll give you some investment dosh if you cut referrals; we know you’ll invest it back into patient services”.’
GPs offered such incentives must guard against a conflict of interest and prioritise their duty to put the patient’s needs first, urged Dr Poole. ‘When we’re working out what to do and how to save our CCGs from financial ruin, we have got to absolutely remember that our day job is as physicians,’ he said.
‘There is an issue of damaged trust. We have got to be very careful about our professional stature and very clear about our professional obligations.’