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GP commissioners ‘can close NHS productivity gap’

By Lilian Anekwe

The Government's plans to overhaul the NHS and hand GPs commissioning powers are key to helping the health service to improve productivity and deliver better value for money – but only if they are incentivised, according to the King's Fund.

The think-tank estimates that the NHS will face a £14bn ‘productivity gap' in the coming years based on the small real terms increase in funding promised by the coalition government, and equates to a need to find productivity improvements of 3-4% a year if the NHS is to maintain quality and avoid cutting services.

Their review of the evidence about the options available to the NHS shows that the majority of the productivity gains needed can be delivered by GP commissioning groups working to increase productivity – but warned GPs would need ‘real incentives' to take on the work.

‘The hope is that this will motivate primary care teams to review the way in which they provide care – for example, by increasing generic prescribing, reducing unplanned admissions, and offering alternatives to hospital referral where appropriate', the report states.'

‘Evidence from previous attempts to involve GPs and primary care teams in commissioning services lends support to the argument that this approach has the potential to make a positive contribution to improving quality and productivity.

‘However, the degree to which GPs will be motivated to take part in commissioning is unclear, beyond the small minority of entrepreneurial GPs who have been at the heart of primary care-led commissioning in the past. Also, there will need to be real incentives to reward GPs for the work involved.'

The report also suggests improving the management of patients with long-term conditions, reducing procedures such as tonsillectomies, lower back surgery and grommets ‘with limited or no clinical benefit' could save £110m, while reducing the number of cataract surgeries and hip replacements could save up to £670m.

Raising the standards of weak and low-performing GPs, as identified by the Department of Health's McKinsey analysis, could also save between £0.2 and 0.4 billion.

Professor Chris Ham, chief executive of The King's Fund and a report author said: ‘As the NHS grapples with much smaller increases in funding from 2011, the danger is that the focus on delivering productivity improvements becomes, at best, an end in itself and, at worse, a misunderstanding that it needs to cut budgets.

‘To maintain quality and avoid cutting services, the NHS must focus on delivering more value from the same amount of money, not delivering the same value for less money. This means focusing on the front line teams who provide care to patients and hold the key to delivering the productivity gains needed.

‘There is a significant risk that the structural changes announced in the recent white paper will distract attention, precisely at a time when there needs to be a single-minded focus on closing the £14 billion productivity gap facing the NHS. This risk must be managed so that improving productivity remains the NHS' number one priority.'

Professor Ham: Improving productivity is the NHS' 'number one priority'