GP commissioning leaders have ramped up pressure on practices following the relaunch of the health bill, with the Department of Health's efficiency tsar among senior GPs calling for an 'underbelly' of poor performers to be rooted out.
The Government last week gave the green light to GP consortia – now rebranded clinical commissioning groups - to plough ahead with radical reshaping of local health services, including moves to hold practices to account.
Senior GPs who have backed the Government's modernisation agenda said it was essential to address variation in primary care in order to successfully drive forward the changes and bring NHS finances under control.
Sir John Oldham, a GP and the DH's national clinical lead on quality and productivity, told delegates at the Commissioning 2011 conference in London that there was an 'underbelly' of poor practices that needed to be brought into line with their peers.
Sir John, who leads the QIPP efficiency drive, said: 'We all know there is an underbelly in primary care where we wouldn't have our relatives go, where people see folk in circumstances and buildings we think are unacceptable.'
'The time is now, with the responsibility on us to make sure we deal with that issue and release those resources which might be used more effectively by others.'
Dr Johnny Marshall, chair of the National Association of Primary Care, told the conference GPs needed to 'put their own house in order' as part of a 'cultural revolution' in the NHS, claiming GPs were far better placed than PCTs to tackle unwarranted variation: 'PCTs have struggled to address quality in general practice, perhaps because they struggle to understand general practice. Nobody understands general practice better than GPs.'
A Pulse survey last week indicated a stark divide between commissioning leads and grassroots GPs over the timescale for taking on commissioning, and this week's comments raise the possibility of conflicts within the profession.
Dr Rory McCrea, founder of Chilvers McCrea - acquired by The Practice Plc last year - said a reform of the QOF was required to stamp out poor practice: 'This will require fundamental contract changes to persuade GPs to really get to grips with poor prescribing, referral and out-of-hours care.'
Dr Agnelo Fernandes, chair of the Croydon Healthcare Consortium, said commissioning groups should not offer 'infinite support' to underperforming practice, and needed to 'know when to stop and when to terminate contracts'.