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Commissioning shake-up could be extended across UK

By Gareth Iacobucci

Exclusive: Plans to hand GPs a central role in NHS commissioning could be extended beyond England, with both the Scottish and Northern Irish governments set to re-assess their own health policies in light of the health White Paper.

The dramatic move comes as both GPs and ministers in the devolved nations insisted the UK-wide GP contract could be preserved, despite the coalition's plan to tie a substantial proportion of GP income in England to commissioning targets threatening to drive a wedge between the four different countries' health policies.

The devolved governments in Scotland and Northern Ireland said this week they are determined to hold on to the UK contract - and even appear willing to consider changing course on their own policy to retain some common ground with England.

But the Welsh Government, which has already overseen the complete separation of commissioning and provision in Wales, said it had 'no plans to enable GPs in Wales to commission services'.

Scottish health secretary Nicola Sturgeon told Pulse earlier this year that future contract negotiations would need to reflect the fact that policies north and south of the border were increasingly going their separate ways.

But in a marked shift in tone, the Scottish Government has now pledged for the first time to discuss the possibility of introducing greater GP involvement in commissioning, as it looks at how to adopt aspects of the English White Paper north of the border.

A Scottish government spokesperson told Pulse: ‘The Scottish Government is looking at the Westminster Government's proposals for giving GPs a larger commissioning role as part of their contract to see if there are elements that can further the aim of improved patient care and support the objectives of the Healthcare Quality Strategy for NHS Scotland.'

She added: ‘Although the GP contract is negotiated on a UK-wide basis, there is no reason why there cannot be variations in Scotland. The Scottish Government already negotiates with the BMA in Scotland on some aspects of the contract that are specific to Scotland. However we currently have no plans to introduce an entirely separate Scottish contract.'

The Northern Irish government said it too would look at how to adapt aspects of the White Paper to its own policy.

A DHSSPS spokesperson said: ‘The structural proposals in the White Paper apply to the NHS in England only. However, the general direction – giving GP practices a much greater role in planning and managing health services, and assessing and responding to local patient needs - is very much along the lines of our own plans.'

The spokesperson added: ‘Minister Michael McGimpsey will want to consider all the proposals carefully before deciding whether they need to be reflected in any change to the structures and policies he has recently introduced, which include giving Local Commissioning Groups (which include GPs and other health and social care professionals) a key and evolving role in setting priorities and securing services for their population.'

‘Given the pressures on his budget, Minister McGimpsey certainly shares Andrew Lansley's emphasis on extracting the maximum efficiencies from existing expenditure allocation.'

GPC Scotland chair Dr Dean Marshall said he was keen that the UK contract remained in place, and said the Scottish Government may be looking for 'wriggle room' by pledging to look at commissioning, in case the policy becomes a success in England, and they decided to adopt it in the future.

GP leaders in Wales are also keen to retain a UK-wide deal, and claim this will be possible even if different commissioning responsibilities are written into the English contract.

Dr Brian Dunn, chair of GPC Northern Ireland, said GPs in the province would be trying to ‘retain as much of the UK contract as possible', and said GPs were ready to take on more commissioning responsibility as they look to create greater synergy with England.

‘We would like to see a continuation of the UK contract in Northern Ireland,' he said. ‘We are keen to see commissioning come into Northern Ireland. We would be very happy to see the facilitation of commissioning to allow it to be extended to Northern Ireland.'

Plans for GP commissioning in England have thrown the future of the UK-wide contract into question - credit Vaughan Leiberum, Flickr Plans for GP commissioning in England have thrown the future of the UK-wide contract into question - credit Vaughan Leiberum, Flickr More on GP commissioning at the NAPC Annual Conference

A top line-up of expert speakers – including Sir David Nicholson, Mark Britnell and Stephen Dorrell MP - will be addressing the latest developments in GP commissioning at the NAPC Annual Conference in Birmingham in October.

To find out more and book your place today please click here.