GP-led health centres offer just what the commissioners of the new NHS will be looking for, says Dr Rupert Bankart
GP-led health centres, or Darzi centres as they are often known, are not about privatisation, but about QIPP – quality, innovation, productivity and prevention.
As GPs, we like our comfort zones and understandably feel threatened by the new and the different. ‘So you are a private Australian company on the stock exchange?' a neighbouring GP partner asked me at a medical meeting in town, when I had just moved home and family to start our GP-led health centre in 2009.
I could understand his misconceptions. But having worked in the NHS all my life, with a passion and sense of responsibility to do my part to ensure the NHS continues to be run by those who understand grassroots and hands-on healthcare, nothing could have been further from the truth.
The world continues to change fast, and we GPs are destined to commission and
re-commission all sorts of services for the NHS. What will we, as commissioners, be looking for in this new world?
Some things are already clear.
We have limited resources, and therefore cost-effective services that offer excellent medical care will be like gold dust. We will have patients on our commissioning boards and we will be answerable to a whole range of local and national organisations – HealthWatch, local authorities' health and wellbeing boards, the Care Quality Commission and Monitor, to name a few.
Let us imagine therefore that we are commissioning a generic service and provider X offers us:
• the lowest cost
• excellent medical care, scoring well above 95% QOF or equivalent quality indicators, proven on past history
• low and appropriate secondary care referral rates
• low and appropriate drugs costs on its pharmaceutical budget
• a strong, caring and patient-centred ethos
• a demand management scheme that helps to reduce patient admissions and casualty attendances.
As commissioners, surely we would bite this provider's hand off.
Now GPs, of course, will not be commissioning primary care services. That will be for the NHS Commissioning Board. But let us, as future commissioners, imagine just for a moment that this was our responsibility. Provider X is a GP-led health centre and has been working for two years to all of the above standards. Would we really want to decommission this service?
We should decommission services based on the quality and efficiency of the service, not on whether they are GP-led health centres or operate under APMS contracts.
It is not about GP-led health centres. It is about quality, productivity, innovation and prevention. It is not about provider organisation structure, it is about the best care for patients. It is not about new or incumbent long-standing NHS provider status, but about responsiveness to patient needs.
It is not about privatisation, but about savings on budget.
If we move away from a patient-centred service, be it in the consulting room or on the commissioning board, then we will sell our patients short and no longer offer value for money. At best, we would offer a substandard service – and at worst, a blatant monopoly.
Speaking as both a long-standing NHS GP and as the provider of a new GP-led health centre, I know – and can demonstrate – that we have achieved all of the above rigorous criteria ensuring the very highest quality and efficiency. And while I am not privy to the accounts and details of neighbouring equitable access services, I am sure that many other GP-led health centres will have equalled or bettered our significant achievements.
As PCTs across the country therefore decide the fate of their GP-led health centres, they should not consider the label, but rather best quality and value. In doing so, they will be putting the patient at the centre of the NHS and ensuring they set quality decision standards, not just for now but as a trend for future commissioners.
Dr Rupert Bankart is GP medical director of the Alma Road Primary Care Centre in Peterborough
Rupert Bankart
