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GP commissioners will duck unpopular health service closures, warns NHS Alliance

By Ian Quinn

GP commissioning groups will not be big enough or powerful enough to drive the quality agenda in primary care, the NHS Alliance has warned.

A new report by the body also claims that GPs are not best placed to explain hard rationing decisions to patients and will shy away from decisions which they fear will make them unpopular.

It is the latest sign of a rowing back from the NHS Alliance over the Government's plans for GPs' powerful new commissioning role, after it warned earlier this week that the blanket nationwide rollout planned by health secretary Andrew Lansley must be piloted first.

The new paper urges the Government and trusts not to dispense with strong PCT clinical management of primary care, saying that positions such as PEC chairs will be pivotal in the months ahead during the move towards GP commissioning.

With 95% of commissioning earmarked to move from PCTs to GP consortia and plans to slash trust management costs by 40%, the NHS Alliance claims GPs will struggle with various aspects of care vital to maintain quality and patient safety, including:

• Driving improved quality, such as leading the QIPP agenda

• Explaining to the public why difficult rationing decisions are being made

• Supporting the reconfiguration of clinical services, which could include supporting the closure of a local hospital where it will result in improved quality of care due to the concentration of services

• Reducing variation in the quality of clinical care provided by doctors.

Dr Sunil Gupta, the paper's author and a member of the NHS Alliance's National PEC Chair Network, said: ‘The GP consortia may find these roles difficult to do because they are either not big or powerful enough. They may also decide not to take on a particular role which will make them unpopular with patients.'

‘The NHS will face very difficult financial circumstances in the next few years and will need to make significant changes to improve cost effectiveness and quality. This will involve making some difficult decisions to support financial balance.'

‘The clinical leaders at the PCT level are ideally suited to help provide this ‘tough love' to the NHS for the best long-term interests of the people of this country.'

GP consortia could shy away from tough decisions such as closing hospitals, the report predicts GP consortia could shy away from tough decisions such as closing hospitals, the report predicts