By Gareth Iacobucci
Health secretary Andrew Lansley has taken the BMA to task over its opposition to his ‘any willing provider' policy, and made it clear that the Government has no intention of reversing its drive to stimulate competition in the NHS.
In an exclusive interview with Pulse, the health secretary argued the policy would not only drive innovation, but act as a vital tool for tackling conflicts of interest among GP commissioners. GPs, he said, would be prevented from simply referring to services in which they held a financial stake by the need to offer patients a full choice.
Mr Lansley also disclosed that payment by results tariffs would be extended to primary care by 2013, to ensure GPs couldn't make excessive profits from services they provided by making them work to a set price.
Shaking off his usual relaxed demeanour, Mr Lansley delivered a stern riposte to the BMA after the association outlined its ‘profound opposition' to his plans to increase NHS competition, and warned they risked pitting GP commissioners against providers and fragmenting patient care.
The health secretary has made great play of his willingness to listen, but on this point he was bullish – accusing doctors' leaders of attempting to block innovation in the NHS and insisting he had no intention of changing tack. ‘The BMA and some others take a view that they do not agree with an any willing provider approach,' he told Pulse. ‘They want to hark back to the idea there are somehow bodies within the NHS and everybody else isn't.
‘We had a mandate to move to an any willing provider approach – it was in our manifesto and the Lib Dems'. I understand some people cling to the idea that the NHS must be a protected organisation, immune from innovation and enterprise, but actually I think innovation and enterprise is what we need.'
Mr Lansley said the requirement to offer a choice of provider would be crucial in tackling accusations of conflict of interest in GP commissioning groups, highlighted recently by a Pulse investigation showing as many as one GP in four has an investment in a local private provider of NHS services.
‘When GPs do that referral, part of the contractual obligation will be to provide patients with choice. So they have to offer the choice and demonstrate they've offered choice,' he said.
‘We're also intending to have extended tariff arrangements out into the community by the time legal responsibility transfers in 2013. So general practice won't be able to take an excess profit because they will be transparently contracting within a tariff framework, where they would have to demonstrate they have met quality standards and the price available from other providers.'
Mr Lansley was giving his first interview since the Government's comprehensive spending review, but if that gruelling process has left him looking tired, it doesn't seem to have dulled his focus or enthusiasm. He used the interview to set out the timetable to GPs taking over commissioning and disclose new details about the financial support GPs would receive during the transition period to full budget holding. Shadow consortia would get some, but less than half, of their management allowance in 2011/12, and in many cases control of ‘the great majority of the management resources' in 2012/13, he said.
The health secretary added that there would be a major trimming of the functions currently done by PCTs, with some scrapped altogether, and GP consortia only taking responsibilities specifically relating to commissioning care for patients.
He said: ‘Some of the apprehension has been when people have looked at everything a PCT does and assumed they will have to do all those things. Of course they won't.'
But one responsibility that will be heading GPs' way is for the overall commissioning budget, including any debt hanging over from the previous regime.
Mr Lansley made clear the Department of Health would not wipe PCT debts in preparation for the handover to GPs and stressed how important it was that GPs helped trusts to get their financial houses in order.
‘Asking GPs to start with legacy debts would mean they would be set up to fail. The object is we arrive at a place in April 2013 where GP consortia are set up to succeed. That does not mean in their own health economy they can just carry on and the debts will be written off. It won't work like that.'
Mr Lansley has now had a chance to digest the numerous and varied responses to his radical NHS white paper, which he said he was ‘very hopeful' would be laid before parliament before the end of the year.
Not all those responses were positive, but the health secretary remains resolute in his belief that GPs have both the skills and motivation to put his plans into action: ‘I would characterise the response from general practice as enthusiastic but apprehensive. I can understand GPs wanting answers to questions. But more people I'm meeting are saying "we kind of get it now – this is actually about us deciding these things".'Andrew Lansley Andrew Lansley on...GPs inheriting PCT debts Andrew Lansley on...GPs taking on rationing Andrew Lansley on...responses to the white paper consultation Watch the full interview with Andrew Lansley