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Right-wing think tank in scathing attack on Conservatives’ GP plans



By Ian QuinnExclusive: A right-of-centre think tank has launched a strong attack on Conservative plans for GPs to take control of commissioning, suggesting they could prove expensive at a time of financial crisis.A Conservative victory would precipitate a shake-up in the role of GPs, with practices being handed real budgets and put in charge of commissioning a range of services, including out-of-hours care.But Civitas – which wants the NHS to be more fully exposed to market forces – said it believed many GPs did not want the responsibility of taking on a greater role in commissioning.It said the system could have some benefits where GPs were keen, but would be more costly than current arrangements and could widen health inequalities and reduce patient satisfaction.The claim was part of a wide-ranging critique of Conservative health pledges in an analysis made exclusively available to Pulse.James Gubb, director of the Civitas health unit, said the plan to have GPs commissioning services was ‘in effect reintroducing GP fundholding’.Such a strategy, he warned, would lead to ‘relative high management costs, no effects on the rate of innovation, introduced inequalities in patient care and lower patient satisfaction’. He said there might also be some benefits, such as reduced waiting times, improved access to care and a wider range of available services, but only where GPs were enthusiastic.He added: ‘The fact is a lot of GPs don’t want to take it on.’ The Conservatives did not respond to the criticism this week, but shadow health secretary Andrew Lansley has claimed that the party’s policies have ‘consistently been supported by GPs’.Dr Sam Everington, a GP in Tower Hamlets, east London, and former deputy chair of the BMA, said he was a supporter of the Tory plans, insisting GPs were in a ‘unique position’ to provide a collective view of the needs of patients. He said: ‘GPs are already responsible for about 80% of expenditure because of our referrals. The message I get from a lot of GPs is about the workload at the moment. If they could be freed up, I think the answer would be yes, they do want to engage in decision making.’ Civitas also claimed the Conservative party’s commitment to protect health spending in real terms was ‘dishonest’. Mr Gubb said: ‘Given the current state of public finances, this would entail cuts to other Government departments of over 3.4% per annum.’ He suggested that Tory moves to scrap targets and rely far more on outcome measures in the QOF were not backed by enough levers to help drive up standards.He said: ‘Studies show that targets probably had more effect than anything else over the past decade. There are problems with relying solely on outcome measures. They can be a blunt instrument for judging performance.’ Civitas even criticised the Conservatives’ plans to open up the NHS market, claiming ‘the mechanism does not seem strong enough to drive the required improvements, unless a number of issues are addressed’. These included the inability of private firms to access private NHS pensions and ‘ridiculously long’ tendering times.Andrew Lansley: plans under fire from leading health think tank Andrew Lansley: plans under fire from leading health think tank