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Leading GPs get cold feet on DH commissioning plans

A group of senior GPs has withdrawn its support for the Government's far-reaching GP commissioning plans amid fears a new framework to hold practices financially accountable could send many to the wall.

Ministers have unveiled plans for GPs to face comprehensive checks on their referrals and accept a share of the financial risk, following Treasury concerns that there was too little to prevent GPs overspending.

Health secretary Andrew Lansley also announced last week that GP commissioning groups would be held accountable via the new NHS Board for cutting ‘mortality amenable to healthcare' and premature deaths from heart and lung disease, and stroke.

But the NHS Alliance, a leading advocate of GP commissioning, told Pulse it now believed the Department of Health's plans were too radical and risky for most practices, and called for them to be scaled back, and piloted before any rollout.

Mr Lansley plans a major consultation with the profession on his plans, which are likely to be unveiled in a white paper within days.

NHS Alliance chair Dr Michael Dixon, who has been advising the DH on the proposals, warned it was over-ambitious to expect groups of GPs to take over commissioning within two years, claiming only around 5% of GPs were currently ready.

Dr Dixon said: ‘There is a fear among many GPs that to accommodate front-runners they will have to take on a level of accountability they don't want.'

‘There is a strong argument that the practices who are ready should go ahead in pilots. If they come unstuck it wouldn't be a disaster and they would be audited carefully. The rest of commissioning would stay with PCTs but with much more say given to GPs on local commissioning decisions. That way you please the Bank of England and GPs.'

Mr Lansley's plans would require GPs to take over commissioning in half the time it has taken for practice-based commissioning to make limited progress – and have attracted scathing criticism from NHS chief executive Sir David Nicholson.

He told the NHS Confederation conference the time frame was hugely optimistic and poured scorn on the ability of GPs to take on the task, saying the best PBC groups would score ‘about a three' if rated out of 10.

Dr David Jenner, PBC lead for the NHS Alliance, told Pulse: ‘David Nicholson was brave enough to say what a lot of people are thinking,' and urged Mr Lansley to ‘pause for breath' before implementing his plans.

Dr Johnny Marshall, chair of the National Association of Primary Care, also backed a staggered rollout, but said rather than pilots GPs should be allowed to take responsibility for budgets in a series of parallel cohorts: ‘There are GPs who are very enthusiastic and want to be managing budgets. But there is a real tension out there.'

GP negotiators strongly support the DH plans in principle but claim to have had no details about the funding plans or accountability measures, despite the health secretary saying he has consulted them.

Dr Chaand Nagpaul, GPC lead negotiator on commissioning, said: ‘GPs are fed up at having token representation on PCTs. What Mr Lansley has proposed would give us real influence.'