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Cuts – they’re your responsibility now

By Richard Hoey

GPs have traditionally set themselves in opposition when frontline services are chopped, but this time they’ll be the executioners, says Pulse editor By Richard Hoey

Seven months ago, a number of leading GPs, including Londonwide LMCs chief executive Dr Michelle Drage and LMC chair Dr Kambiz Boomla, joined a protest against sweeping reorganisation and cost-cutting across London’s healthcare.

A couple of months later, a larger protest saw GPs and patients marching side by side to fight for the future of the NHS.

Back then, we were still in the comfy old world where the managerial bureaucracy – in this case NHS London – came up with a ridiculous centralised plan to impose change on general practice, and GPs busied themselves with slapping it down.

A lot has changed in the last few months, including NHS finances, which have gone from dodgy to increasingly alarming. Pulse this week revealed a document from NHS London admitting ‘London no longer has a legitimate medium-term financial strategy’.

The biggest change though is the identity of the group of people expected to sort out the mess. It was faceless managers… now, under health secretary Andrew Lansley’s plans to consult with general practice over all big decisions, it’s GPs.

So, NHS London plans to ram home the consequences to GPs of ‘doing nothing’, while PCTs elsewhere prepare to persuade GPs to sign off cuts, in the case of two trusts, of a daunting £200m over three years.

All this is going to require a significant psychological adjustment among GPs. It’s my impression that most so far have little appreciation of the scale of the responsibility heading their way, actually far sooner than the formal commissioning handover.

And how does a doctor like Dr Sam Everington, famous for the patient-centred, integrated approach offered by his Bromley by Bow health centre, adjust to being responsible for denying patients services, rather than offering an array of them?

Maybe, the key will be in erecting some pretty sturdy glass walls between consortia, which are increasingly looking like being big, PCT-size organisations equipped to make the hefty budgetary decisions – and practices, with their key ongoing role in acting as advocates for patients, and protectors of their services.

Essentially, it’s about splitting our perceptions of what a GP is, dividing them into clinical leaders and good old-fashioned doctors.

Of course, enough GPs will need to opt for leadership roles to give the big decisions legitmacy.

But under this analysis, it’s not just acceptable for many other GPs to play a relatively minor role in commissioning – it’s absolutely essential for the system to work.

It’s therefore equally essential that practices are not paid by their ability to put cuts into action – by, for instance, reducing the number of patients they refer to hospital.

If all GPs have a hand on the knife that makes the cuts, then patients will spot their fingerprints.

And then GPs will never again be able to march shoulder to shoulder with patients when services are the victim of cutbacks.

By Richard Hoey, Pulse editor