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GPs must re-focus cuts towards primary care, says leading think tank

By Gareth Iacobucci

GP consortia should re-focus the QIPP agenda to generate bigger savings from within primary care, says the Nuffield Trust.

The think tank has also called for PCT clusters to be given proper assurance from Government that they can survive beyond 2013 in order to give GP consortia sufficiently robust support during the handover of power.

A new report from the trust - NHS Reforms in England: managing the transition assesses the reforms in light of the Department of Health's Operating Framework for the NHS for 2011/12, which it says will be a ‘substantial challenge for the NHS'.

It warns of significant risks associated with the ‘unprecedented' reforms, and outlines a series of measures it says should be put in place to mitigate risk during the transition.

The report says the QIPP agenda should be accelerated by PCT clusters in conjunction with GP consortia during 2011/23, and said primary care should be a key focus, with too much attention so far being paid to making savings from within secondary care.

It says: ‘The second-largest area of health spending by PCTs is primary health care – this made up 20 per cent of health care purchased by PCTs in 2009/10. The Operating Framework says very little about productivity in primary care; this is a concern.'

The report adds that the NHS must ‘strengthen the arrangements for performance management of primary care during the transition to GP commissioning'.

The report adds it is ‘hard to see how [PCT clusters] will be dissolved in two years' without destablising areas such as performance management, primary care contracting and QIPP.

It also recommends that reducing avoidable admissions to hospital should be made ‘a core target' for PCT clusters and GP commissioners.

Anita Charlesworth, Chief Economist at the Nuffield Trust and co-author of the report added: ‘It is unrealistic to imagine that the overall efficiency challenge for the NHS can be met through a reduction in costs in hospitals and management cost savings alone, when together these account for less than half of PCT spending.

'Given the reduction, in real terms, in recurrent funding available to PCTs, there will be a need for initiatives associated with the efficiency drive to be accelerated, with a key focus being given in the coming year to primary care.'

Judith Smith, head of policy at the Nuffield Trust and co-author of the report said it was 'critical' that PCTs were given the time and resources to ease the transition. She said: ‘It is critical that staff, in particular managers, are supported adequately to make the reforms work, and at least maintain the quality of care during this time of transition'.

Key recommendations

• The DH should offer PCT clusters assurance of their future beyond two years, and outline an order of priority to the list of service developments required of PCT clusters.

• Extend integrated performance measures for PCTs and GP consortia should include primary care indicators.

• QIPP must be extended if the NHS is to make and maintain progress in meeting efficiency targets, given reduced real‑terms funding.

• Primary care should be a key focus on the QIPP agenda in 2011/12 and the NHS needs to strengthen the arrangements for performance management of primary care during the transition to GP commissioning.

• Reducing avoidable emergency admissions should be a core target for PCT clusters and GP commissioners, as a fundamental part of the QIPP agenda.

• Clear guidance should be developed about what are acceptable governance and structural arrangements for emerging GP consortia, in order that accountability to the public for the quality and performance of local services, and of funding decisions, can be assured.

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