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Pathfinder GPs join calls to slow commissioning handover

By Ian Quinn

GP pathfinders have joined calls for the Government to scrap its April 2013 deadline for the handover of commissioning from PCTs, warning they need more time to get buy in from practices on the ground.

A report by the Policy Exchange, an influential conservative think tank, describes the experiences of 16 of the first wave of GP pathfinders and uncovers widespread fears over the timescale of the changes, the structure and size of GP consortia and disagreement over the role of the private sector.

The report comes at the start of a Government 'listening exercise' on the NHS reforms and urges ministers not to ‘sweep under the carpet' the concerns of pathfinders covering millions of patients calling for a ‘slower pace' of change.

At the weekend, MP Norman Lamb, the chief political adviser to deputy prime minister Nick Clegg and former health Liberal Democrat spokesperson, put more pressure on health secretary Andrew Lansley to slow down his plans and keep PCTs in place in some areas past 2013. He called for a shift from 'revolution to one of evolution'.

His comments echo passages from the Policy Exchange report that say GP pathfinders are concerned about the speed of the changes, and about getting buy in from all local practices.

Author Eve Norridge, a former policy adviser to the Treasury, spoke to pathfinder leads in groups with a range of 14,000 to 660,000 patients, and found: ‘GPs expressed concerns about the consequences of the short timescale for the abolition of PCTs.

'Some fear that commissioning knowledge and expertise which has built up will be lost in the transition and that if GPs are left with a vacuum they will not be able to try out innovative but potentially risky ideas.

'Where GPs lack enthusiasm it does call into question the likelihood of them delivering transformation in NHS care,' it adds. ‘The Department of Health is driving forward the pathfinder programme at high speed. There is a danger that they are pushing groups together before the ground work has been done to bring the group members on board. '

The report says some of the consortia leads were ‘not supportive of the Government's plans' and while most showed enthusiasm says it is ‘worrying that some of the GPs and managers in charge of the groups that should be paving the way for the new policy do not feel they can fully back it.'

Winning support from practices will be vital, say the report, which singles out Cumbria and Kingston as good examples, with Kingston having made ‘getting buy-in from local GPs its first priority.'

‘Some will be ready for this but others will not. This will be particularly the case where consortia are developing from scratch rather than from successful practice-based commissioning groups, which have already had years to evolve.'

In some places the report finds bitterness and infighting, reporting one GP who attacks 'self-appointed leaders who may not necessarily be those best placed to actually deliver the improvement required'. Another says his consortium leader 'seems biased and does not listen to all of the members'.

Pathfinders also accuse the Government of interfering in their plans to form consortia from the bottom up.

‘A lead GP of one of the very largest pathfinder consortia revealed that he and other local GPs had wanted to create seven different groups,' says the report. ‘ However, they were told the Department of Health only wanted three or four pathfinders in the whole region so they had no choice but to form one huge group.'

In another case ‘one lead GP reported his consortium had been forced to work with a group of practice which did not share the ethos of the rest of the group.'

The report also reveals wide-variation in attitudes towards bring in private sector firm to provide support. While a quarter of pathfinders it interviews had already done so and many more were considering it, some have made an ideological decision against it with one SHA slapping a ‘a blanket ban on working with the private sector.'

However, the pathfinders have one thing in common. Almost all have begun scrutiny of GP referrals, many looking at individual GPs.

‘There was almost universal agreement that referral rates need to be monitored at least at GP practice level and ideally at individual; GP level,' says the report.

Dr Charles Alessi, chair of NAPC London and member of the clinical management team at the Kingston GP consortium, called on the Government to allow GP consortia to take over from PCTs at different stages, while giving maximum support to pathfinders to allow it to happen as soon as possible.

He said: ‘The pace of change needs to be guided by the level of engagement that exists in certain areas and the pathfinders. This is going to take a long time.

‘But I would suggest we don't wait until 2013 but start putting in the support now.'

Mr Lamb and other Liberal Democrats are calling for a much slower timescale to be changes, urging the Government to allow PCT clusters to remain in place in areas where GP pathfinders are not ready to take on commissioning in April 2013.

He said: 'The key is to shift from a perception of revolution to one of evolution.'

What pathfidners are saying: Pathfinder report

*Almost all pathfinders monitoring referrals at practice or individual GP level

*A quarter using private firms for support, with many more considering it, although some banning use private sector

*Pathfinders complaining of DH interference over their size and structure

*Some pathfinders disillusioned at having to work with GPs who don't share their ethos

*Complaints of lack of framework of external support

*Lack of clarity over conflict of interests hampeting pathfinder development

Source: Implementation models for GP consortia: the Policy Exchange

Dr Charles Alessi