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Pressure mounts on general practice to deliver health reforms



The NHS reforms will only succeed in keeping patients out of hospital if general practice increases it capability and capacity, according to the Department of Heath’s commissioning network lead, Dr James Kingsland.

Speaking at today’s NAPC annual conference, Dr Kingsland, said: ‘We’ve got to to recognise this reform is as much about change to primary care provision as to buying services differently.

‘This is the biggest challenge in delivery from general practice – the capacity and capabilities in general practice.

‘We want to see a transformation in provision as much as commissioning, I think CCGs are going to have a real role in transforming their members’ providers services as much as buying services differently.

‘It’s the micro-systems, the behaviour change in day-to-day practice that is going to be about as much of the reform as large-scale new commissioning.’

His comments followed some tough talk by Earl Howe, Parliamentary Under-Secretary of State earlier at the conference on how the Department of Health would endeavour to reach agreement with the BMA on a new GP contract but  ‘would not back away from making changes that deliver better care for patients.’

Lord Victor Adebowale, appointed earlier this year as a non-executive director of the NHS Commissioning Board, told the conference the biggest risk with the reforms was to make a ‘whole load of structural change and end up with the NHS.’

‘And what I mean by that, isn’t that the NHS is a bad thing but that we make a lot of structural change, spend a couple of billion quid and the culture and the communication and the hierarchy remain the same.

‘I have every respect for primary care and GPs but if you assume that the world revolves around the fact you are the cleverest people in the room, we are doomed.’

He added there was an economic as well as moral argument to address the inverse care law – where those who most need care do not receive it.

‘We’re not going to achieve that unless you (primary care) do something that is very, very difficult for highly trained, evidence-led professionals to do which is become risk aware as opposed to risk averse. Which (requires you)  to understand the boundaries and connections between your profession and others and to establish modes of collaboration.

Later in the expert panel session, Lord Adebowale, said there was as ‘much chance of politics being taken out of the NHS as a UFO landing on my nose’ when responding to a question from the floor by East Surrey CCG chair, Dr Joe McGilligan on how politicians could begin to take tough decisions in their own backyards – rather than protect trusts.

 Lord Adebowale, chief executive of Turning Point, said: ‘ Don’t be surpised if the general public get concerned about the closure of the hospital if no-one’s presented them with a clear vision of what it should be replaced with.’

Former Number 10 health adviser, Professor Paul Corrigan, said: ‘The NHS tends to so enrage the public in its reconfigurations that by the time it gets to MPs there is nobody in favour of anything it puts forward and so you give MPs the opportunity of supporting something that no member of the public wants.’  

Professor Corrigan , director of strategy and commissioning for NHS London SHA added what would change things was when ‘a doctor stands against a member of parliament on the basis the current hospital is killing people.’