By Ian Quinn
The GP body most closely aligned to date with the Government's sweeping white paper reforms has called for GP consortia to hold individual GP contracts, with the power to terminate the employment of those who fail to pass tough new performance management measures.
The National Association of Primary Care (NAPC) says in its response to the Government's health white paper that GPs should be answerable to their consortia leaders, rather than the NHS commissioning board.
The response calls on the Government to build on a ‘paradigm shift in thinking within general practice', with individual GPs held to account for delivering better value for money services for the NHS.
Under its plan, as well as holding GPs' contracts, GP consortia would publish data about the performance of every GP in their organisation, with ‘prior approval for certain referrals or procedures' needed to be given.
It also calls for GPs to be given financial incentives to bring down the cost of care.
The NAPC said there needs to be new mechanisms in place that ‘exert significant influence on the behaviours of clinicians' for Andrew Lansley's reforms to work.
It argues that, for the commissioning board to work effectively, it must be a lean organisation that empowers GP consortia and holds them to account for delivering improved outcomes.
‘The current proposal is that the board would hold the primary care contracts for general practice. In order to performance manage general practice against these contracts it would require significant data flows on practice performance. As the lean organisation it is intended to be it would be difficult to see how it could fulfil that role,' said the NAPC.
It added: ‘Delivery of outcomes could impose a requirement upon commissioning consortia to performance manage GP practices, which supports out argument that primary care contracts should be devolved.'
NAPC chair Dr Johnny Marshall, said: ‘We have lobbied long and hard to bring about a set of conditions, which place patients and primary care clinicians, through their relationships, firmly in the driving seat of the NHS.
‘The white paper offers exactly the right set of conditions to deliver increased productivity, while at the same time continually driving up the quality of care patients receive and deserve.
‘We need to place a much greater emphasis on prevention and self-care, offering our patients the tools and resources to engage more fully in managing their health'.
Dr Charles Alessi, executive member of the NAPC, said it was ‘wholeheartedly behind the direction of travel and on board for the journey'.
The NAPC has given the Government by far the must enthusiastic response to date in its consultation, with organisations including the BMA, the RCGP and the King's Fund having expressed major concerns about the extent and the pace of change.
A survey of 827 doctors by ComRes found less than a quarter agreed putting GPs in charge of budgets would lead to a noticeable improvement for patients.
Shadow health secretary, Andy Burnham, said: ‘Andrew Lansley is in a hole and he needs to stop digging. He simply cannot continue to ignore the grave concerns being raised about his plans for the NHS.
‘This is too great a risk to take at a time when the NHS is facing an unprecedented financial challenge'.Dr Johnny Marshall: GPs need new incentives and performance management Dr Johnny Marshall: GPs need new incentives and performance management