By announcing significant changes to the controversial NHS reform plans, the Government has demonstrated that it has listened to the concerns of health professionals and patients.
The commissioning of services, previously planned to be the sole preserve of GPs, will now also involve doctors and nurses and public representatives. A National Commissioning Board will be set up to control budgets until GP groups are ready to take over. The Prime Minister also dropped his April 2013 deadline for the new commissioning arrangements to be introduced and has given GPs more time to prepare for the transition.
Although a wider group of players will be involved in commissioning services, GPs will still be at the heart of it. They will initiate between £60 billion and £70 billion of healthcare spending every year, alongside hospital doctors and nurses and under proper public governance. This is good news because I am convinced that to meet the health and financial challenges of the future, GPs must play an important role.
GPs are best placed to commission new and more appropriate services. More than one million people in the UK visit a GP surgery each day. This level of contact means that GPs are ideally positioned to understand the needs of the local population.
By signing a hospital referral letter or a prescribing pad, GPs initiate a significant amount of the £100 billion spent on healthcare in English NHS.
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I struggle to think of a single industry where the people who have either a direct or indirect influence on spend do not have a degree of involvement in taking responsibility.
GPs are in the best position to see the whole care pathway of any particular disease as they have links into secondary care, within primary care and with the social care part of the local authority. This overview and appreciation of the linkages means that GPs, alongside patients, are in an excellent position to suggest improvements that will directly enhance the quality of patient care.
One key aspect of commissioning services is determining how to manage clinical risk. GPs manage risk every day when they are making judgments about caring for people at home rather than referring into hospital. Thus, GPs can be a valuable part of commissioning, particularly when the debate involves shifting care from a hospital to a community setting. The value of this expertise has been demonstrated in a number of ways; placing GPs into A&E teams, for example, has ensured that fewer people are admitted into hospital in a number of cases.
To make the necessary savings and maintain or even improve the standard of care, we need to change a health model that is still based on the hospital-dominated service of the 1950s and 1960s. Society today is grappling with new diseases often linked to chronic long-term illness. These diseases require much less hospital intervention and instead can be managed effectively by GPs and health practitioners in the community.
Giving GPs a lead role in future decisionmaking — alongside hospital doctors and nurses — will give us the chance to rise to the challenge and solve the NHS’s £20 billion efficiency conundrum.
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• Gary Belfield is an associate partner at KPMG