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So is the Government getting cold feet over its GP commissioning plans?

By Richard Hoey

The rumblings of discontent over Lansley's plans are understandable, but if GPs are wrapped up in too much red tape, we'll be left with PBC all over again, says Pulse editor By Richard Hoey

Health secretary Andrew Lansley's plans to hand GPs responsibility for 80% of the entire NHS budget are bold, brash and ambitious… so it was almost inevitable that the Treasury would not like them.

Mr Lansley has now conceded he will need to toughen up the safeguards over his proposals if he his going to keep the money men happy, announcing there will be systems to ensure GPs are held accountable for the cash they spend.

It's not clear though whether his hand has been forced simply by the habitually cautious Treasury, in its traditional role slapping down an enthusiastic new minister, or by a more fundamental disagreement about the policy at the heart of the coalition.

Certainly, there's evidence that it could be the latter, with a senior Government source telling Pulse there are ‘tensions' behind the scenes between the coalition partners over the plans.

This was predictable enough – indeed, I suggested back in April that there was plenty of work to do to reconcile the two parties' manifesto commitments on health.

Liberal Democrats are suspicious of plans to hand too much power to GPs, arguing that whoever commissions for the NHS must justify their decisions to the public. That was the reason why the Lib Dems included proposals to elect members to the boards of primary care trusts.

And while that policy still officially stands, it rather lost its power to act as any kind of a consolation to the junior coalition partners when it became clear that PCTs are going to be reduced to powerless rumps, stripped of 95% of their commissioning functions.

Hence the furore over GP commissioning. How does the public get to hold the NHS to account for how it spends its money, if the NHS has passed on responsibility to 500 or so GP federations – essentially independent businesses?

It may be that the Government's Health Watch plans, which Pulse revealed last week, are going to be given real teeth.

Health Watch is to be a national body representing patients that will be split into local watchdogs, who will publish data about GP practices… and perhaps that could include monitoring referral patterns, spending decisions and anything that looks suspiciously like a conflict of interest.

Now, it is only right that if GPs are going to take on this enormous new budgetary responsibility, that there is some mechanism to hold them to account for all that taxpayers'cash.

But all the same, a few alarm bells are ringing here. One of the reasons practice-based commissioning became so discredited was that managers were using it as a performance-management tool… it wouldn't do to go down that path again.

And GPs could end up being hammered twice here. Hammered firstly by being made to take on more responsibility for commissioning than they are ready for or equipped to cope with. And hammered secondly for every little mistake they make.

If that was the case, it wouldn't only be within the Government that there would be rumblings of discontent. It would be within general practice, too.

By Richard Hoey, Pulse editor NAPC conference

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