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GPs to be hit by tough new accountability measures under White Paper plans

By Ian Quinn

GPs are facing far tougher regulation over their accountability under health secretary Andrew Lansley's plans to hand them control over 95% of PCT commissioning budgets.

Mr Lansley revealed the new health White Paper, due out next month, will include a new framework to hold GPs to account for their commissioning decisions.

It came as the Government revealed it would launch a major consultation exercise after it publishes the White Paper, which will set out in detail its plans for GPs to take on real budgets, with all practices expected to work under federations.

The health secretary's pledge followed senior figures expressing alarm at the lack of economic accountability of GP contracts, with influential advisers to the Government calling for all GPs to be made to answer for their commissioning decisions.

The moves could see GPs forced to submit to much wider checks on data regarding all their patient referrals as well as taking on financial risk as part of the new function.

It has been reported today that the fear over the lack of accountability may put back the health bill being prepared by Mr Lansley and his team to pave the way for GP federations to take on the key role in solving the NHS financial crisis.

Government sources told Pulse there were 'tensions' between plans to allow local decision making by GPs and the need to hold practices to account to the new independent health commissioning board.

Speaking at the NHS Confederation conference yesterday, Mr Lansley promised GP commissioners 'greater autonomy, under greater public scrutiny', adding: 'With responsibility comes a new kind of accountability. In recent years there has been a degree of pretence when it comes to accountability at the centre.'

Also speaking at the conference, NHS medical director, Sir Bruce Keogh, described primary care as a ‘regulation free zone'.

He said: 'I think we are going to see that, as GPs become more responsible for the NHS budget, lines of accountability both clinical and financial are going to change. We are going to have to look closer at this and that is on the agenda.'

He added: 'If we start to look at the referral patterns of practices that might have a real effect.'

As exclusively reported by Pulse two weeks ago, the NAPC, which has been in talks with Mr Lansley, has been calling on the Government to draw up tough measures to root out GPs who fail to commission services efficiently and to reward those who take on the most responsibility and commission most effectively with higher pay.

NAPC Chief Executive, Mike Ramsden, said: ‘We strongly welcome the coalition Government's plans to devolve commissioning responsibility to primary care but with responsibility should come accountability and we believe GPs and other primary care team members can be held accountable for their commissioning, as well as clinical decisions.'

The GPC has pledged to fight moves to force all GPs to take on responsibility for commissioning and for it to be linked to their pay and has also vowed to resist a widespread renegotiation of contracts.

But Earl Howe, parliamentary under secretary of state for health, told the Lords yesterday that the Government would re-write the GP contract to include 'more responsibility and control over commissioning budgets' adding that it would 'help GPs consider the financial consequences of their clinical decisions.'

'This will lead to reducing waste and bureaucracy,' said Earl Howe.

Today the Guardian claimed the Treasury was stonewalling over the publication of the health white paper, because senior officials are concerned there is not enough provision for making GPs accountable to the public, given they would control 80% of the £100bn NHS budget.

It reported a senior official as saying: ‘The white paper got bounced back because there was no way the Treasury could sign up to a proposal which handed £80bn of public money to 35,000 GPs who are basically unaccountable private businesses.'

Andrew Lansley is wrestling over how to hold GPs to account for new role Andrew Lansley is wrestling over how to hold GPs to account for new role