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Everyone agrees that debts would be a disaster for GPs

By Richard Hoey

Senior NHS managers and Andrew Lansley himself admit debt would be a major blow to consortia, and that gives our campaign a real chance of success, says Pulse editor By Richard Hoey

Normally, campaigns mark out areas of acute disagreement.

Campaigners attempt to marshal opinion, to demonstrate they have right on their side, to challenge authority and persuade those in power to demonstrate they do have a reverse gear.

All of those things apply to Pulse’s A Clean Slate campaign, as it pushes to persuade the Government not to pass over debts to GP consortia when they take on commissioning, and yet… it’s still a campaign with a bit of a difference.

Because its central argument, that it would be hugely damaging for GPs to begin their commissioning responsibilities loaded with the debt of the old regime, is accepted by pretty much everyone.

Health secretary Andew Lansley himself said GPs would be ‘set up to fail’ if they began commissioning with legacy debts.

David Stout, head of the NHS Confederation’s PCT Network, warns it would be ‘utterly disastrous’ if debts were allowed to accumulate over the next two years, and says it would ‘kill the health economy’ if GPs had to pay them back within a year.

But that apparent agreement over the potential outcome does not equate to a consensus over how to avoid it. Stout, while accepting there could be a case for ‘some kind of amnesty’ argues on balance against it, and Lansley too continues to insist PCT debts will not be wiped, even as he acknowledges the damage that could cause.

So why is the Government being so stubborn about this, even as our survey shows the damage it could do to GPs’ engagement with commissioning, and why have some NHS managers reacted with such alarm to our campaign on the Pulse website?

The concern seems to be that if GPs don’t feel threatened by a potential mountain of debt, they won’t cooperate with trusts in helping to erode it. Quite apart from the lack of faith this shows in GPs’ professionalism, the argument has a flaw, which is exposed by some of those who make it.

Several of the comments from managers on our site insist that wiping debts is pointless, because if the fundamental inefficiencies in the local health economy aren’t addressed, then the debt will just recur the following year.

That argument ignores the psychological effect of making a fresh start with an old debt, and the sense of injustice that comes from being left in the red by decisions you didn’t make. But it also completely undermines the argument that removing the threat of debt will take away GPs’ incentives to work with PCTs on efficiencies now.

GPs have a major incentive to work with PCTs, because reshaping a health economy to become more efficient takes time, and there isn’t much of that left.

No one is arguing that GPs shouldn’t do their best to help the NHS avoid financial meltdown. The disagreement is all centred around who bears responsibility if it does.

Click here for more from the Editor’s Blog By Richard Hoey, Pulse editor Click here to read more about our campaign A Clean Slate