Debt paralyses pioneer consortium

By Gareth Iacobucci

Exclusive: A pioneer GP consortium that has taken over part of its PCT budget early has been left unable to reshape care because it has been so constrained by the huge debt it inherited, one of its leaders has told Pulse.

Dr Joe McGilligan, a GP in Redhill, Surrey, and chair of the ESyDoc consortium of 20 practices, warned inheriting debt had turned commissioning into a ‘poisoned chalice', after being drafted in to help tackle a projected £125m overspend.

Dr McGilligan, a leading advocate of the Government's commissioning plans, said his group had been hamstrung from the start by the debt it had been forced to inherit and blocked from investing in areas of care it knew would ultimately save money.

His warning came as NHS Surrey was enveloped in a media storm last week over its latest plans to block access to a swathe of services, including IVF, in an attempt to tackle a debt that remains at £35m even after several rounds of cutbacks.

Pulse launched a new campaign, A Clean Slate, last week to spare GPs from inheriting debt, after revealing that struggling PCTs like Surrey were running up deficits heading for more than £300m in total by the end of the financial year.

Dr McGilligan backed the campaign, and warned GPs' enthusiasm for commissioning would be severely tested if they inherited debts like those in Surrey: ‘My cluster has been involved in practice-based commissioning for four years and is predicted to be the only one in Surrey to actually have a surplus this year. The rest of Surrey is completely bankrupt.

‘The problems are not of our making. There has been mis-management for years and now suddenly we've been given a poisoned chalice. It's almost impossible to get any activity going because there is no money available to do it.'

He added: ‘A lot of GPs are very wary. It's not that the will isn't there, it's just that the ability to effect change isn't there. It is completely frustrating. We've had plans for two years we haven't been able to get going at all, which we know would save money.'

Dr McGilligan's comments came as it emerged GP commissioners have just weeks to persuade ministers that they should not inherit PCT debts.

NHS South West has already pledged no debts will be handed to GPs, with surpluses shifted around to cancel deficits. But the remaining nine SHAs say they will make no decision until the Department of Health publishes its NHS operating framework for 2011/12 in December. Health secretary Andrew Lansley insisted indebted PCTs would not be bailed out.

But Pulse's campaign is urging the DH and NHS managers to rigorously hold PCTs to account for their finances until the 2013 handover, and to clear all remaining debts before GPs take over, so they can begin commissioning on an even footing.

A DH spokesperson said: ‘We are working with SHAs to address circumstances where PCTs owe money, with the expectation any debt will be fully resolved by the end of 2012/13.'

Pulse believes passing PCT debts to GPs will hamper efforts to get commissioning off the ground and widen health inequalities.

Our A Clean Slate campaign is demanding GPs take over commissioning on an equal footing, without the burden of debt. We are urging the DH and NHS managers to:

• Rigorously hold PCTs to account for their finances for as long as they remain legally responsible.

• Clear all residual debts before GPs take over, either from central NHS surpluses, or by moving money between PCTs.

To pledge your support for A Clean Slate, please email cleanslate@pulsetoday.co.uk