Exclusive: GP commissioners are putting pressure on practices to reconsider acting as advocates for patients appealing Continuing Care funding decisions, as clinical commissioning groups struggle to bring overspends under control.
Health East CIC, a CCG in Norfolk, has written to practices in Great Yarmouth urging them to be cautious in supporting appeals to Continuing Care panels – a move local GPs claimed was effectively asking them to ‘reconsider their proper role as patient advocate’.
GP leaders warned the row highlighted an ‘inevitable’ conflict in GPs’ new commissioning role, as practices struggle to balance individual patients’ interests with the need to ration limited resources.
Board papers show that NHS Great Yarmouth and Waveney is already £4.2m over budget for Continuing Care cases in 2011/12, and is forecasting an end-of-year overspend of £7m – 75% over budget. The papers flag up ‘high concerns over the sharp increase in Continuing Care’ spend and identify the area as one of a series of financial ‘pressure points’ to be tackled by commissioners this year.
Continuing Care funding is allocated to patients if panels deem them eligible for free care outside of hospital, including medical, nursing care and social care.
Minutes from the Clinical Commissioning Committee show that Dr John Stammers, chair of Health East CIC, wrote to practices ‘stressing awareness and [the] importance of the situation’ regarding the Continuing Care overspend.
NHS Great Yarmouth and Waveney and Health East CIC refused to release a full copy of the email. But writing in Norfolk and Waveney LMC newsletter, medical secretary Dr Simon Lockett said ‘concern has been expressed to the LMC that this email was, in effect, asking GPs to reconsider their proper role as patient advocate’.
‘The email gave the frightening facts about the Continuing Care budget, explained a little about the system for judging applications, which is as fair as it can be, and asked GPs to be cautious when considering supporting appeals,’ he said.
‘The mention of the budget, followed by the suggestion that GPs might now change their actions was, perhaps, an unfortunate juxtaposition.’
He added: ‘If GPs were to do anything other than support their patients by giving factual information to Continuing Care panels, as and when requested, then that would clearly be improper.’
‘I believe that GPs generally, quite rightly, bend over backwards to help their patients.’
GP leaders warned doctors were likely to come under further pressure to put budgets ahead of patients under the NHS reforms.
Dr Clare Gerada, RCGP chair, said: ‘GPs should always be mindful of the public purse, but we have a role and responsibility to the patient in front of us and argue their case first and foremost. This kind of thing is inevitable; it is going to complicate GPs and their relationship with their patients. I just think this is not an area GPs are going to be comfortable with.’
In a joint statement to Pulse, Andy Evans, chief executive of HealthEast CIC and Dr Ian Hume, Norfolk and Waveney LMC chair, said:‘Continuing Care is a costly but critical service that HealthEast will be commissioning in the future. As such it is important that our local GPs fully understand the complex decisions taken.’