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McKinsey secrets behind GP shake up published at last

By Ian Quinn

Crisis-hit NHS London today finally published details of plans for a massive shake up of GP services drawn up on the back of reports by American consultant McKinsey.

The report had formed the basis of proposals for a huge shift in care from hospitals to polyclinics, which were scrapped yesterday by new health secretary Andrew Lansley.

Having dodged repeated attempts by politicians and health campaigners to publish the documents, NHS London said it was now ‘time to draw a line in the sand' and publish details of the report, which it now admits will never be completed.

The documents confirm the extent to which health chiefs in London planned to shift care from hospitals to cheaper GP settings to save money, as it faces up to a £5bn black hold in its budget.

They include confirmation of plans to slash GP appointment times by an average of 20%.

However, the latest analysis of its ambitious plans also reveal ‘frustration' at the lack of progress in the move to polyclinics in the capital.

‘There is frustration with the overall pace of change and frustration at large number of small initiatives rather than fewer transformational initiatives,' say the documents.

They add that elements of the original vision for London, drawn up by Lord Darzi, had been ‘diluted' and that ‘change has not been as dramatic as outlined.'

‘Significantly, the core principles (and expected savings) of polysystems have proven difficult to achieve with more focus on the buildings rather than the changes to care and behaviours.'

The report adds that frontline services in London ‘lack key capabilities and capacity for implementation when set against competing priorities and operational challenges.'

Elsewhere the documents reveals plans to:

• Reduce the average appointment time by 20% allowing GPs to ‘spent more time where it is needed'

• Increase the amount of time GPs and nurses spend with patients, saving in the region of £600million, with the report claiming GPs typically spend 18.5 hours of their contracted 37.5 hours per week on direct patient facing care.

• Plans for greater use of nurse practitioners and other community staff, with the current rate of 33% of primary care appointments that are nurse led increasing to 50% to free up GPs.

Despite the plans for such a huge shift to GP care from hospitals, McKinsey's consultation called for major reductions in primary care spending by 2016/17 by up to £1bn, while it called for 30% of outpatients services to be de-commissioned altogether.

A spokeperson for NHS London said: ‘Fixing a date for publication has been problematic as it has become clear that there will be no final version. This is because the study has constantly evolved over time to take into account new information and priorities and while further analysis was completed. The general election has also delayed publication.

‘NHS London recognises that it is time to draw a line in the sand and make the study public. ‘

Polyclinics have failed to achieve the savings predicted Polyclinics have failed to achieve the savings predicted