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Trusts allowed ‘open cheque book’ while GP budgets are dwindling, warns NHS Alliance chief



The current payments system for primary and secondary care is ‘anti-competitive’, allowing trusts ‘an open cheque book’ while GPs are left with a ‘fixed and dwindling budget’, the chair of the NHS Alliance has warned.

Speaking at the organisation’s annual conference in London today, Dr Michael Dixon said that GP commissioners have a ‘year window’ to prove they can reform healthcare, while GPs must embrace the ‘accountable clinician’ model or see their status as professionals diminish as other providers muscle in and take on such roles themselves.

Dr Dixon said that CCGs are hampered by competition regulations.

He said: ‘There will also be the ongoing obstacle of market rules and competition – themselves becoming a new bureaucracy – intimidating commissioners rather than enabling them; obstructing much needed change.’

‘Speaking of competition, perhaps we could start by dismantling an anti-competitive system, which pins down the resources of primary care with a fixed and dwindling budget based on capitation – the same system that offers hospitals an open cheque book and ever increasing proportion of the NHS budget by allowing them to charge for anything that they can persuade anyone to have done to them.’

GP commissioners can help change this system and address problems such as the ‘epidemic of long-term disease’, avoidable deaths and an ‘alienated, stressed, angry, cruel and fragmented society, which itself causes so much long-term disease’, he said.

He added: ‘Time, however, is short. The vultures, waiting to deprive primary care of its new commissioning role, are circling. We have a narrow window of no more than a year in which to show we can make a difference.’

Dr Dixon, who is also a GP in Collumpton, Devon, welcomed the ‘accountable clinician’ model for the care of elderly patients introduced in the GP contract, and urged GPs to embrace the model.

He said: ‘Accountable care organisations may lie at the end of this road for many, but we must continue to ensure good and personal accountable care for patients, and we must also maintain the “small is beautiful” bit of general practice as we extend our role.’

‘Within this lies a solemn health warning for general practice: if we don’t achieve this, and do so within a very short time, then somebody else will. If we don’t choose to become accountable clinicians for our frail elderly, for instance, then other organisations with ambitious plans may decide to supplant rather than support us. “Threat”, they say, “Is an opportunity to evolve” – today, general practice must evolve or die.’

Dr Dixon also described the pressures that GP are under. He said: ‘In the last ten years there has been a 20% reduction in the general practice share of the NHS budget, supported by 40% fewer district nurses. When I started general practice there were three GPs to every consultant. Today there are more consultants than GPs.  Little wonder that a GP partner of mine described herself last week as feeling pulverised.’