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Lansley relying on GPs’ good will

The move to give GP consortia management cash from April is welcome, but there is a significant sting in the tail.

Here are the tools, now get on with the job. That’s the message from health secretary Andrew Lansley in Pulse’s exclusive interview this week.

GP consortia will get a significant proportion, although less than half, of their management allowance from next April, and almost the entire amount the following year for their commissioning dry-run. That represents a significant upfront investment from the Department of Health, and Mr Lansley is bound to attract flak from opposition politicians for the expense of running GP managerial operations in parallel with PCTs. He is right though to bite the bullet on this cost, because GPs across the country will simply not be ready for commissioning unless fully supported over the transition period.

Any thoughts, however, that GPs might have two years of practice before being expected to be perfect should be consigned to the world of fluffy white clouds. There is a significant sting in the tail. Mr Lansley makes clear that the DH will not wipe PCT debts when the official takeover happens, in April 2013, and that it is therefore imperative GPs work with trusts now to drag their local health economies back into the black. The consequences, if GPs are unable to help PCTs get their acts together, are alarming even by Mr Lansley’s own assessment. He says consortia would be ‘set up to fail’ if there are still debts hanging over them when the transition comes.

Handing general practice such a degree of responsibility and risk is in some ways an honour, although perhaps a dubious one. It requires GPs to be ready and willing to step up to the plate, and begin marrying managerial excellence to their clinical skills. Mr Lansley is relying on an enormous amount of good will. He may get it, but certain decisions by his Government have certainly made his job harder. The DH’s suspension of the usual pay review process for English GPs still hurts. It makes for a potentially bruising set of negotiations with the BMA, which was the target of some unusually sharp words from Mr Lansley for its strong opposition to the white paper’s ‘any willing provider’ policy.

GP negotiators won’t win on any willing provider, which is burned into Mr Lansley’s DNA as the key to neutralising GPs’ conflicts of interest through the sterilising effect of patient choice. The GPC though could score some victories elsewhere. Mr Lansley’s reforms rely heavily on GPs, without offering much in the way of incentives or rewards. The negotiators must ensure that changes, before GPs agree to pick up their tools.

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