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By Jonathan Isaby

Policy Exchange new logo I have already written this morning about the ongoing speculation about what the Government is going to do with its NHS reforms.

Right on cue comes another contribution to the debate this morning from the think-tank Policy Exchange.

It has just issued a paper, Implementing GP Commissioning, by Eve Norridge, a former head of the public services team in the Conservative Research Department and policy adviser at the Treasury.

She is in favour of the commissioning model favoured by Andrew Lansley, but uses the report to urge the Government not to move so fast:

"In recent years, GP involvement in commissioning has received widespread support from politicians of all parties and across the NHS. It would be a loss to everyone if it were discredited and the emerging consensus destroyed through overly rapid implementation. The changes that are planned are a natural next step from trials in the 1990s and from Labour's practice-based commissioning programme.

"However, the government has lost many potential supporters, both inside and outside the NHS, through pressing ahead with them so quickly. If these issues are simply swept under the carpet then patient care may suffer in the transfer to the new system and further undermine confidence in the proposals. On the other hand, if the hard work is done to slow things down, to bring sceptics back on board and to lay a solid evidence base for the scheme, then its potential to deliver real and lasting transformation in the NHS is enormous."


She adds:

"There are many GPs who have the potential to become highly successful commissioners. It would be a loss to everyone, especially patients, if the policy were discredited due to overly hasty implementation.”

“Our report argues that GPs will need to support the new system if it is going to be a success. Ministers need to address GPs’ concerns before loading such huge new responsibilities on their shoulders.

“The danger is that GPs take part so reluctantly in the new scheme that it ends up replicating the existing model rather than becoming the new and innovative system the Government desires.”

It is a 56-page paper and can be downloaded here.

Among Norridge's key recommendations are the following:

  • GP consortia should be statutorily established at the size level where most decisions are best taken – between 30,000 and 210,000 patients.  In order to achieve the stated aim of bringing commissioning closer to patients and best align clinical and financial decision-making, their size should tend towards the lower end of this scale, (Recommendation 4)
  • The government should slow down its plans for the abolition of Primary Care Trusts in order to give GP commissioning the time and space to develop innovatively, to ensure expertise is not lost in the transition and in order to allow responsibilities to be handed over to GPs at a slower pace where this is appropriate. (Recommendation 6)
  • GPs will need to maintain high standards of communication with their patients to ensure that trust is maintained.  They will need to be able to demonstrate strong examples of successful commissioning from an early stage, involve patients in decision-making and make sure they have very clear supporting evidence in cases where they are not providing a particular drug or treatment to a patient. Consortia need to make sure that they do not make patient involvement a secondary issue, but embed it in their plans from the start. (Recommendation 11)
  • The government needs to clarify how it intends to implement its plans for an NHS Commissioning Board and to confirm that it in abolishing Primary Care Trusts it is not simply displacing many of their bureaucratic functions to this new entity. (Recommendation 12)  
  • As it works on a formula for allocations to consortia, the government should provide a stronger incentive for GPs to work in deprived areas through giving a higher ‘patient premium’ to those GPs who do so. (Recommendation 14)
  • To help GPs fully back the government’s plans for commissioning: best practice needs to be shared around the country; consortia leaders need to be chosen fairly; GPs need help to develop the skills they feel they lack; commissioning must not be an unremunerated, ‘extra-curricular’ activity; and GP consortia must be allowed to develop more slowly where more time is needed to win over their GPs. (Recommendation 15)

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