Lansley unveils tough new quality measures planned for GP commissioning revamp

By Gareth Iacobucci

Health secretary Andrew Lansley says the Government's ambitious commissioning agenda for GPs will carry extra cash tied to tough new outcome targets, such as reducing mortality for cancer and heart disease.

Addressing GPs and secondary care consultants at the BMA's annual representatives meeting, Andrew Lansley said he wanted GPs to be at the heart of his Government's reforms to re-focus healthcare on the delivery of outcomes and expressed his desire to foster a ‘constructive' and ‘positive' relationship with the profession.

The health secretary unveiled plans for a new national outcomes framework which would be used to ‘hold the new NHS Commissioning Board to account.' He suggested a raft of new outcome targets including:

• Mortality rates affected by the NHS brought down to the level of comparable countries

• Improving one and five year survival rates for cancer at least in line with EU averages

• Reducing premature mortality from stroke, heart disease and lung disease, so that they are at least in line with EU averages

• Year-on-year improvement in patient-reported outcomes for patients living with long-term conditions

• Year-on-year improvement in patients' satisfaction with their access to and experiences of healthcare, and

• Year-on-year reduction in the number of adverse events

Mr Lansley also revealed quality standards developed by NICE - those for stroke, dementia and the prevention of VTE were published today - wouldl be used to judge the quality of GP care.

The health secretary said the NHS must be focused on ‘achieving continuously improving outcomes for patients - not inputs or processes, but results,' adding: ‘I can't count how many times doctors have told me, on a personal and professional level, how frustrated they are by the way the system works. How their judgments and activities are restricted by the rigidity of the system, and how their clinical priorities have been distorted by narrow process targets.'

‘For too long the focus has been on measuring inputs and processes that are remote to patients. The result has been the number of managers in the NHS increasing three times faster than the number of nurses, and a proliferation of targets - with over 100 major targets now governing your every movement. So we are beginning to dismantle this system.'

Last week the DH published revisions to the Operating Framework effectively scrapping the 18-week target for hospital waiting times, the four hour A&E target and the 48 hour target for GP access.

‘Together we need to develop a small but balanced set of national outcomes measures that encompass the three things that we need to focus on to improve quality - the effectiveness, experience and safety of care,' said Mr Lansley, who is due to launch a full consultation on his plans in the wake of a White Paper due out next month.

Turning to the proposed shake-up of GP commissioning, he said he had already held discussions with the GPC, confirming Pulse's stories that the system would involve GPs ‘working in local consortia, supported by an independent NHS Commissioning Board.'

All clinicians 'must take on a much greater role,' he said, warning that the expectations would be written into contracts.

‘GPs will be expected to work closely with hospital consultants and their colleagues in all parts of the profession. We'll work through the details with the BMA and we'll negotiate those aspects that affect the GP contract.

Saying he wanted to appeal to all GPs to take more responsibility, Mr Lansley said: ‘Giving GPs greater commissioning responsibility isn't about detracting from the support you give to individual patients.

'Rather, it is about making sure that the really important decisions about the services available to your patients - and the quality you expect from the people providing those services - are driven by your clinical insight.

‘As the Royal College of Physicians argues - the responsibility for the use of resources is now a core responsibility for the whole profession.'

Responding to a question of how GPs will be incentivised to participate in commissioning, Mr Lansley said GPs would be resourced to commission services as individual practices, and as larger geographical consortia.

‘Where general practice is concerned, I am aware that responsibility should come with resources to make that happen,' he said.

‘There are already resources in the GP contract [but] if we're going to do this job, there's got to be levers to make this happen.'

Mr Lansley said he understood some GPs' concerns about taking on burdensome managerial responsibilities, but said giving GPs leadership roles wouldn't negate the need for good NHS managers.

‘I don't want you to be managers, I want you to be leaders,' he said. 'I hope we keep good managers.'

NAPC Annual Conference – all you need to know about GP commissioning and practice business and finance. For more information, go to www.napcannual.co.uk.

To read the full transcript of health secretary Andrew Lansley's keynote speech, please click here.