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Buckman warns Lansley: ‘No commissioning in the contract’



By Gareth Iacobucci

Exclusive: The GPC is to oppose a series of central tenets of the Government’s plans for GP commissioning, including moves to make it a contractual obligation of practices, its chair Dr Laurence Buckman has told Pulse.

In an exclusive interview, Dr Buckman made clear that writing commissioning into the GMS contract would undermine the role of the GPC in negotiating on behalf of GPs across the UK.

He also insisted practices would have to be paid for commissioning, but insisted their income should not be tied to targets for staying within budget or driving down referral rates.

Dr Buckman’s comments place him on a potential collision course with health secretary Andrew Lansley, who has made clear he does expect the GMS contract in England to be rewritten to reflect the new commissioning role.

Dr Buckman, who gave a typically relaxed but bullish performance, said GPs in England could be given a legal responsibility to engage with their commissioning consortia, via an amendment to the NHS Act.

But he said writing commissioning into the GMS contract would undermine the role of the GPC in negotiating on behalf of GPs across England, Scotland, Wales and Northern Ireland, and instead believed it should be offered as an optional DES.

‘We don’t think the contract is the place to put this,’ he said. ‘It would be very difficult to maintain a UK contract in the face of three countries not having commissioning in the same way.

‘If it’s in the [English] NHS Act, it’s quite easy to make it just as compulsory without being a contractual obligation. It’s a legal obligation.’

Dr Buckman insisted the DES could be general in nature, covering reviews of prescribing and hospital activity, so it could apply in Scotland and Wales, where GPs are unlikely to take over commissioning, as well as England: ‘Those things are country independent – you could have them across the whole UK.’

He added: ‘This work has to be funded somehow, because if I’m doing this I’m not seeing patients, so I’m going to need support either to provide care for patients or provide commissioning activity.’

But he rejected the suggestion by primary care tsar Dr David Colin Thome that GPs would be paid either for reducing ‘inappropriate hospital activity’ or staying within their consortium’s commissioning budget.

‘If there is a suggestion if I under refer, under investigate and under prescribe, somehow I will benefit from that financially, that’s a very dangerous path. I’m happy to be paid to do it, but I don’t want a direct link between what I save and what I receive as payment.’

The GPC chair also warned existing PBC leaders that they might lack the ‘democratic legitimacy’ to be in charge of the larger groups, and poured scorn on those already taking legal advice on forming consortia.

‘A consortium is a completely different structure, involving a lot of people, many of whom will not be enthusiasts. It may well be that PBC groups do not have the democratic legitimacy they are going to need in the new world.’

Dr Laurence Buckman on…

The GP contract
‘If commissioning is in the contract, it would be very difficult to maintain a UK contract.’

Setting up consortia
‘Don’t start going to lawyers, don’t start listening to PCT saying ‘you must do it this way’. This is a talking time, not a business time.’

Leading the changes
‘It may well be that PBC groups do not have the kind of democratic legitimacy they are going to need in the new world.’

Inheriting PCTs’ debts
Where I have a problem, is where GPs opposed things like Darzi centres and PFI, and we’re now going to be faced with that debt.’

Dr Laurence Buckman: income must not be tied to targets for staying under budget Dr Laurence Buckman: income must not be tied to targets for staying under budget