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GPs bite bullet as pathfinders sign off secondary care cuts

By Ian Quinn

GP consortia across England have begun approving the closure of A&E departments and moving a raft of services out of hospitals as the realities of their new responsibilities under GP commissioning hit home.

GPs in several trusts have been plunged into the heart of controversial debates over emergency services and have begun rubber-stamping plans to shut A&E and maternity departments, as they try to turn around cash-strapped PCTs.

NHS London revealed a series of cuts to hospital services would be made after an initial GP-led consultation and approval by an independent panel of clinicians, including GPs, from outside the capital. An A&E department will be closed, some inpatient services stopped and a birth unit placed under review.

Ruth Carnall, chief executive of NHS London, said: ‘The local GPs' clinical review confirmed that no change is not an option.'

Dr Andrew Spooner, an RCGP council member and a GP in Crewe, was one of the independent doctors on the NHS London review panel. He said: ‘The consultation with GPs and GP leaders has been extensive. On balance, the engagement has been in favour of this strategy.'

Dr Tony Grewal, medical director for Londonwide LMCs, said the consultation process had in some cases pitted GP against GP: ‘The majority of GPs do not have the capacity to sift through the huge amount of evidence required to make these decisions. However, given the fornicating shambles commissioning of services has been in for the past 20 years, I'm sure they can't do it any worse.'

Elsewhere, pathfinder groups across England have begun moving funding out of hospital services. The Victoria Commissioning Consortium in Westminster, London, is shifting dermatology, gynaecology and musculoskeletal medicine work into primary care. The Bassetlaw Commissioning Organisation in Nottinghamshire and HealthEast group in Suffolk have similar plans.

Dr John Stammers, chair of HealthEast CIC and a GP in Southwold, Suffolk, said: ‘We are transferring services, such as shared-care protocols for prostatic carcinoma reviews.'

But in other areas, GPs have criticised NHS managers for pushing ahead with reconfigurations against the views of GPs and patients.

Dr Paul Hobday, a member of Kent LMC and a GP in Maidstone – where maternity and paediatric services have been decommissioned at Maidstone hospital, despite overwhelming patient and GP opposition – accused the Government of undermining its own policies.

‘How does closing the local unit increase patient choice? This is not consistent with putting GPs in the commissioning driving seat,' he said.

Pathfinders groups have been cutting or transferring secondary care services