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Free GPs from debt, and they’ll deliver

The scale of PCT debt leaves the profession in an impossible position

GPs who inherit debts from PCTs will be ‘set up to fail'. Not the words of an angry GPC member or an alarmed commissioning lead, but of our health secretary, Andrew Lansley. But for Mr Lansley, that's not a reason to ensure all such debts are wiped before GPs take over. On the contrary, it is a powerful lever, effectively a threat, to encourage GPs to get involved in clearing deficits now.

But as Pulse's investigation reveals, this particular pile of debt really is going to take some wiping. Even the notoriously optimistic end-of-year forecasts are projecting an accumulated deficit in indebted trusts of more than £300m, at an average of almost £10m each. That's all heading GPs' way, with the Department of Health making clear it has no intention of bailing trusts out.

It leaves the profession in an impossible position. Either GPs become complicit in desperate cuts to local healthcare, that they know will harm their patients, or they enter the new world of commissioning behind the game and hamstrung by deficit.

It's to spare GPs that unacceptable dilemma that Pulse is launching a new campaign, A Clean Slate, to ensure all consortia begin their statutory commissioning responsibilities in the same place, with zero debt, and an equal chance of reshaping care for their patients.

Our campaign argues PCTs should be held accountable for debts for as long as they are legally responsible, but when GPs take over those debts should be wiped, either from central NHS surpluses, or by sharing funds between neighbouring trusts, as is already planned in the South West. That call will be resisted by some NHS managers, who claim without the threat of debt it will be impossible to engage GPs in tough commissioning decisions. But Pulse's survey finds quite the opposite – that expecting GPs to inherit debts will have a wholly negative effect on their involvement in commissioning. As many as 74% say the prospect of an inherited deficit would make them less likely to play an active commissioning role.

GPs will expect to take responsibility for deficits generated on their watch. But the DH is trying to hold them to account for someone else's debts. Sure, GPs can suggest ways PCTs could get out of the financial mess, but there's no guarantee they'll be taken up. And until they get the protection of a statutory body, GPs are likely to feel constrained by GMC guidance from suggesting the kind of radical cuts to patient care likely to be the only short-term route out of this crisis.

Nor is the logic internally consistent. The Government is drawing up a new funding formula for GP consortia partly because it feels PCT allocations have been unfair, with many areas now in the red arguing they have been the victims. How strange for ministers to claim there has been an injustice, while playing an active role in perpetuating it.

Victims of injustice or not, many of those areas hit by debt are among the poorest – Haringey, Warrington, Bradford. GPs there will want to use the opportunities of commissioning to build a better future for their patients. But in order to do so, they need to begin with a clean slate.

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