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GPs should not be responsible for hospital cuts, thinktank warns

By Alisdair Stirling

NHS managers – and not GPs – should shoulder the responsibility of hospital cutbacks, a new report claims.

The report – from health sector think tank The King’s Fund – urges the Government to rewrite the Health and Social Care Bill to empower the new NHS Commissioning Board to drive through hospital reforms because it says ‘GP consortia are unlikely to able to to fill the role’.

GPs are already in the firing line for hospital reconfigurations, facing closures without being consulted and being blamed for cuts they have not instígated.

Pulse reported in August that GPs in Kent were facing the closure of their local maternity and paediatric services, in spite of a survey showing four out of five opposed the plans.

And last month, GPs in Kingston, Surrey were blamed for the loss of 500 jobs at Kingston Hospital. Public sector union Unison claimed the Kingston GP Consortium were behind the £13.1 million cuts which will see one in five posts go.

The King’s Fund report is based on an analysis of a reorganisation in south east London, originally launched in 2005, which affects Guy’s and St Thomas’, King’s College Hospital and four district general hospitals – Queen Elizabeth Woolwich, University Hospital Lewisham, Queen Mary’s Sidcup and Bromley Hospitals Trust.

NHS London said last December that the proposed changes – to include a large reduction in acute capacity at Queen Mary´s – had gained support from GPs, but the Kings Fund report says that although the changes had ‘explicit’ GP backing, it was far from unanimous.

The report acknowledged that with the NHS needing to find up to £20 billion in productivity improvements over the next few years, major changes to the provision of hospital services were urgent and essential.

But it argued that market forces alone would not deliver the necessary rationalisation and warned that GP consortia were unlikely to be able to fill the gap left by SHAs who currently oversee hospital strategy.

The report’s author, Keith Palmer, chair of Cambridge Economic Policy Associates said: ‘With the NHS facing an unprecedented financial challenge, major changes to the way hospital services are provided are essential.

‘Relying on market forces alone will not deliver the changes needed, with the risk that patient care will suffer. It is vital that the health bill currently before Parliament provides the right levers to drive the changes needed.’

But Dr Charles Alessi, a GP and chair of the Kingston GP Consortium said he believed service changes were impossible without the involvement of GP consortia: ‘I disagree with the King´s Fund. This should not be left to the NHS Commissioning Board.

‘As a consortium, if you involve patients and commission the services they need, that will inevitably lead to and have an effect on reorganisation. If not we might a well go home. None of us want to go back to the 50s and 60s when it was impossible to change things.’

A Department of Health spokesperson defended the policy of leaving hospital cutbacks to GPs: ‘We urgently need to modernise the NHS. Giving GPs freedom to design services around patients will deliver benefits in terms of improved services that deliver better outcomes, improved patient experience, and more efficient management of NHS resources.’

GPs should not be responsible for hospital cuts, the Kings Fund say King’s Fund report