Edward Davies: GP Commissioning. Again.

Edward DaviesHere at Groundhog Day, I mean the NHS Confederation annual shindig, the talk of the conference floor is GP commissioning. Health Secretary Andrew Lansley’s speech last night was pretty low on laughs, but what he lacked in charisma he made up for in trumpeting this latest idea.

And when I say latest idea, I of course mean regurgitated failure.

This morning, I’ve just come back from a discussion session on GP commissioning with a representative from social services, one from Patient Voice and the president of the National Association of Primary Care (NAPC), James Kingsland. It was Dr Kingsland’s words that struck me most.

The NAPC has been around in some form or other for 20 years, he reminded us. It has been at the GP commissioning vanguard during fundholding, PMS plus, PCGs and most recently practice based commissioning, which began over five years ago. “We will have to be prepared for incremental uptake,” he said of this latest dawn. “There will be slow adopters,” he warned. “There is challenge ahead,” he cautioned. “Blah Blah blah,” I think he said.

Stop. Just stop. Twenty years of fruitlessly banging your head against the wall of GP commissioning is not “incremental uptake” or “slow adopters.” It’s self harm. Fundholding was not just seen as difficult in some areas but a total disaster. Swathes of London never got on board at all. The latest incarnation in practice based commissioning was described by the government’s own primary care tzar, David Colin-Thome, as a “corpse not for resuscitating” (http://careers.bmj.com/careers/advice/view-article.html?id=20000505). There are whole trusts where GPs are showing as much interest in the idea as a vegetarian in a steakhouse.

The reality is that an awful lot of GPs want to do radical stuff like treat patients, not deal with commissioning budgets. At the recent meeting of local medical committee heads, these most politically engaged of GPs caused some surprise by saying they would accept commissioning responsibility for out-of-hours care if the government sought to impose it. But despite these being some of the most engaged GPs in the country, voting on a very hot and imminent topic, the vote just scraped through by 52% to 48%. (http://careers.bmj.com/careers/advice/view-article.html?id=20001145)

It’s all very well saying GPs will do this but who’s going to make them? Many just don’t want to.

And then comes the moment of real genius. To make this work GPs will be divided into consortia for oversight. There will be several hundred of these groups around the country. All the primary care team will have a say in these, not just GPs. They will be a sort of, hmm, primary care “trust”…. Of course these groups will need to be managed in some way and we can’t be too prescriptive, so they may seek to elect a medical director or co-opt a manager from the PCT with expertise and experience in commissioning. Is any of this sounding familiar now? A sort of “primary care trust manager” trying to coerce unwilling GPs into some sort of commissioning arrangement?

I sat in the auditorium listening to earnest questions from the floor barely able to restrain myself from shouting: “Look, the emperor’s got no clothes! Can you people not see! You are being asked to do the same thing all over again in a totally different, exactly the same way.”

What do I know? I’ve never had to manage a commissioning budget as a GP or manager, I’ve never referred a single patient, and I’m acutely aware that NHS management talks a financial language which is totally alien to my Luddite ear.

But it does feel horribly like I’ve been to this conference before. And I suspect I’ll be attending for years to come.

Edward Davies is the editor of Career Focus.