By Ian Quinn
The Government's primary care tsar has dismissed calls for GP consortia to be granted tough new powers to performance-manage practices, claiming that GPs will be alienated and the system will fail if it is perceived as a draconian crackdown on their contracts.
Dr David Colin-Thome, national clinical director for primary care, told MPs the Government was determined to move away from a top-down bureaucratic approach to a ‘softer' process of engaging GPs in decision making.
‘The first reaction [in the past] has always been to create a contractual relationship,' said Dr Colin-Thome. ‘It's this that has alienated so many clinicians. It becomes a bureaucratic exercise.'
His pledge came as the House of Commons health committee inquiry into health secretary Andrew Lansley's commissioning plans saw Department of Health leaders quizzed over what plans were in place for consortia and the new NHS commissioning board to hold GPs to account.
Dr Colin-Thome's comments come despite calls from the National Association of Primary Care for the Government to allow consortia to hold individual GP contracts and to have the power to terminate the employment of those who fail to pass tough new performance-management measures.
In its response to the white paper, the NAPC said consortia would need new mechanisms in place to ‘exert significant influence on the behaviours of clinicians'.
But Dr Colin-Thome said an obsession with contractual levers was the reason behind the failure of practice-based commissioning, adding: 'Unless you change that you will get clinical disengagement.'
The committee hearing also saw NHS chief executive Sir David Nicholson grilled by a newly-elected Conservative MP, who served as a GP for 16 years, over why consortia had not been piloted first, despite a lack of evidence that GPs were equipped to take control over NHS finances.
Dr Sarah Wollaston, MP for Totnes in Devon, said: ‘Would it not have been better to have piloted it in certain areas? Most people accept that having clinical leadership will make a difference but the fact is this is a massive re-organisation and there doesn't appear to be any piloting of this particular model.'
Sir David, who has previously slammed the ability of GP commissioners, telling NHS managers in June even the best GP practice-based commissioners scored 'only about a three' in terms of quality, told MPs yesterday that GPs had a wealth of commissioning experience ‘going back over 20 years.'
'There is a huge body of experience and knowledge about what works,' he said.
On the lack of evidence to back the new system he said: ‘It's not a random controlled trial but there is a lot of experience and knowledge.'
Sir David also said the Government was planning to have a network of local branches of the NHS commissioning board to support GP consortia and hold them to acount, saying: ‘I think there will be a variety of mechanisms whereby the commissioning board will be powerful nationally but also be active locally.'
Local authorities, he added, would also have powerful new levers to help decide the basis of consortia commissioning plans.
Asked if councils would have a seat at the table in decision-making, he said: ‘Local authorities are the table.'
However, Rosie Cooper, Labour MP for West Lancashire, claimed the prospect of local health and wellbeing boards, which will be set up to oversee consortia at local authority level, holding GPs to account was ‘like throwing snowballs at a moving truck'.
She said she was expecting to have ‘sleepless nights' over the powers to be granted to GP consortia, which would ‘have meetings behind closed doors with no non-executive members to hold them to account.'Dr David Colin-Thome: Government determined to move away from a top-down bureaucratic approach Dr David Colin-Thome: Government determined to move away from a top-down bureaucratic approach Watch the full evidence session