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GPs frozen out of community services

By Gareth Iacobucci

Government figures show GPs have won just 4% of almost £10bn worth of NHS cash divested to date as part of controversial moves to formally separate PCTs commissioning and provider arms by April next year.

The Department of health has revealed that acute trusts, mental health and new Community Foundation Trusts have swallowed up the majority of the £8.5bn worth of services to have been divested so far ahead of the April 2011 deadline, with GPs largely frozen out of the race.

GPs and other community-based providers have gained control of just 4% of the total budget, a situation described as ‘depressing’ by the NHS Alliance, which said GPs had ‘no chance’ of putting winning bids together in such a tight timescale, and warned that the shift would hinder the Government’s GP commissioning agenda by giving too much power to large acute and mental health trusts.

A quarter of community services previously provided by PCTs have been transferred to the acute sector, with 28% going to mental health trusts, and 26% to new Community Foundation Trusts.

A further 10% of the services are now in the hands of social enterprises, with health minister Simon Burns predicting that almost a billion pounds will be re-directed to voluntary organisations to create ‘the most vibrant social enterprise sector in the world.’

He said: ‘These changes to community services will enable clinicians to deliver personalised and responsive care and better outcomes for some of the most vulnerable in our society.’

Ian Dalton, DH managing director of Provider Development and chief executive of North East SHA, said: ‘These plans provide firm foundations for transforming these key services and speeding up the transfer of services out of hospitals and in to local communities and people’s homes.’

But Dr Michael Dixon, NHS chair and a GP in Cullompton, Devon, said the whole shift was at odds with the Government’s white paper and it’s GP commissioning agenda.

He said: ‘I really can’t see the logic of continuing with Transforming Community Services when you’ve got the white paper. The two just don’t fit together.

‘It could have been stopped to give time for frontline clinicians and local people to formulate what they think the best configuration of local services would look like. But because of the tight deadline people have just had to dump them wherever seemed most convenient at short notice.’

He added: ‘They’ve not really given local communities a great chance. It’s a bad start for GP commissioning, as they are going to have to commission against organisations that a much larger than they were previously.

‘It seems to be moving community services in the wrong direction, away from rather than towards general practice. It is really rather sad. What is depressing is I don’t think the frontline of general practice is being listened to.’

A DH spokesman insisted there would be plenty of oppotunities for GPs to be involved via some of the other models. He said: ‘GPs will be involved in other models like social enterprises. There will be lots more opportunities for GPs to be involved.’

Dr Michael Dixon