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Field: Let GPs commission primary care

Exclusive GPs would be able to commission primary care, with the powers to decide how many practices were required in an area and what contracts they should hold, under a proposal being promoted by the chair of the NHS Future Forum, Professor Steve Field.

Professor Field told Pulse there were growing concerns over the powers the NHS Commissioning Board would hold over GP commissioners, and that it should be made to delegate responsibility for primary care to clinical commissioning groups (CCGs).

He argued that the proposal, which comes as the second stage of the listening exercise on the NHS reforms begins, would prevent over-centralisation and promote integration. But the GPC warned it would exacerbate concerns over conflict of interest.

Professor Field spoke to Pulse as a series of new amendments to the health bill were released, including one that would hand CCGs the power to give their members extra pay, pensions or expenses.

He said: ‘More and more I am picking up concerns about the NHS Commissioning Board centralising powers, particularly as the board will be commissioning primary care. This is of real concern.

‘I believe we can ask for delegated responsibilities to really look at integrated care, health and social care, and primary and secondary care. The challenge for GPs is to get on with that sooner rather than later. The longer we leave it, the less impact we will have on central contracts.'

Professor Field said the powers he was proposing would be in addition to those already set out in the health bill, and would be adopted when CCGs had shown themselves to be ready. However the NHS Commissioning Board would retain ultimate responsibility to deal with any conflicts of interest.

Dr James Kingsland, the Department of Health's national clinical commissioning lead, agreed it would make sense for CCGs to take on commissioning of primary care to encourage care to be moved out of hospitals and into communities.

‘We have already started this debate with quality premiums and whether they are payment to a practice or an investment in primary care locally,' he said.

‘It makes sense that over time primary care contracting is devolved down, and it would be more efficient to do so.'

But GPC negotiator Dr Chaand Nagpaul criticised the proposal: ‘There would be concerns about conflict of interest.'

'Contract management with GP practices would have to be conducted at a level higher than a CCG. The definition of primary care would have to be clear and contracts would have to be held with the NHS Board – CCGs could not manage contracts.'

Dr Ron Singer, a retired GP and president of the Medical Practioners' Union, said: ‘This is a very dangerous proposal. We know already GP entrepreneurs are positioning themselves to make fortunes from the NHS through the reforms.

‘The current proposals inherently conflict interests and these changes would only make it worse and lead to the destruction of trust in GPs.'

Click play below to watch Professor Field discuss primary care commissioning.