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GP leaders accept the end of lone practices

By Ian Quinn

GP negotiators expect every practice in the country to join a federation and help manage swathes of the NHS budget after throwing their weight behind the Government's planned overhaul of GP commissioning.

Practices could be asked to form networks with ‘like-minded' colleagues in other parts of the country under the Department of Health plans, but there remains heated debate over the financial penalties for GPs who don't actively commission.

The GPC told Pulse it supported plans for the vast majority of PCT commissioning to transfer to practice groupings, with last week's LMCs conference voting GPs should even take on a ‘central role' in organising out-of-hours care.

But the LMCs conference rejected plans, under discussion by the DH, for a ‘radical' new GP pay model that would provide lucrative incentives to take on commissioning but heavily penalise practices that refused to do so. The National Association of Primary Care is heavily pushing that model in talks with health secretary Andrew Lansley, calling for incentives for GP commissioners to be balanced by the threat to cut funding to those ‘not up to the task'.

Mr Lansley is due to unveil his plans in a health bill that could be published as early as next week, with practice-based commissioning set to be replaced by a new scheme simply called GP Commissioning.

GPC chair Dr Laurence Buckman, speaking at the LMCs conference in London, said he believed all GPs would have to work under a federated system, also referred to as a polysystem, but with different levels of commissioning responsibility.

‘GPs will of course have be resourced to take on this new role,' he said.

With the Government preparing to hand GPs real budgets, LMC representatives voted that the move should ‘always be voluntary' and ‘deplored' any future connection to GPs' income or contractual status.

But Dr James Kingsland, NAPC president, said: ‘We need GPs to be at the leading edge. Too often we look at the tail end who either can't or won't take on responsibilities and invest in them.

‘I sense from our communication with Mr Lansley that we have a chance to change that and invest in success. For GPs who won't or can't deliver, there's got to be a question about whether they are fit to continue.'

Dr Buckman told Pulse he strongly disagreed with the NAPC's suggestions for killing off underperforming practices.

He said: ‘Some GPs are not very good at commissioning, but they would be able to carry on providing healthcare as part of groups commissioning NHS services. As long as they do not obstruct the process I don't see why they shouldn't be able to continue.'

Professor Chris Ham, chief executive of the King's Fund, told the event GPs would work in ‘one-stop shops – polysystems, by any other name'.

He said the Government was considering two options, one that would see GPs group together geographically, or another in which GPs would form networks with like-minded colleagues across the country: ‘My hunch is the Government will want to provide more patient choice and won't want to be seen to support local monopolies, so it may go for groups of like-minded GPs, which would mean it would be keen to break down practice boundaries.'

Dr Laurence Buckman