GP Commissioning – a procurement disaster waiting to happen

The principle that GPs should have more input into commissioning of healthcare than they did under the old PCT system is good. I'm even - whisper it quietly - pretty relaxed about more private involvement in health provision.  But GP Commissioning is shaping up to be a major disaster and could be worth 50 seats to Labour at the next election.

I've written before about some concerns, but a couple of news stories last week just strengthened my view that this is a disaster waiting to happen.

1. This story in the Nursing Times and Health Service Journal - GPs under the 'old' practice based commissioning system re-cycling surpluses (money they don't spend on patient care) into buying equipment and even furniture for their own surgeries.  That means they have to spend less themselves - and as they are independent contractors, that is in effect money straight into their own well-lined pockets. And some GPs applied to use surpluses to fund treatments that they provided themselves privately.

2. The Health Minister, Andrew Lansley, now says he never wanted price based competition between providers and it won't be allowed, as Pulse reports. But last week, David Bennett, the new head of Monitor, the hospitals' regulator, said,

I understand why people are nervous about price competition. 'But over time there will be areas where it is useful.

So how can anyone plan for the procurement processes that will be needed when the guys in charge appear to change their minds on a weekly basis?

As GP commissioning comes into being,  'corruption' or perceived corruption, and fraud, will become major issues. Watch out for (a small number) of GP commissioners diverting money in various interesting directions.  Providers offering conferences and hospitality to GPs in exotic locations. Incompetence will be another issue; some GPs are highly commercial, others are not. Some will engage expensive consultants to do the procurement, giving scope for all sorts of other headlines, ranging from 'waste of money' to 'conflict of interests'.

In summary; while most GPs are wonderful human beings, they are also self-employed business people. As such, I have total confidence in the ability of GPs to 'game' the system in their favour, as they have done through every other strategic change in my lifetime, and particularly when the new commercial model has been as hastily cobbled together as this one.

Meanwhile, hospitals who get limited certainty of volume under the  'any willing provider' approach, or lose out on some small but critical contracts, will go under.

As I've said before, I have no political axe to grind in this area.  And in other areas such as welfare and schools, I think the coalition are on the money.  But I see a runaway health train and the buffers ahead.

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  1. Rob:

    I could spend entire week writing about this one..

    But here’s an interesting article. Some useful facts and figures.

    There are 36,000 GPs, and, as you say, the vast majority (prob 90% by now) are private sector enterprises. The PM wants to hand them £80 billion per annum. The GPs will have to pay another organisation to commission, procure and pay service providers – probably anywhere between 1-3% fee..

    The average GP conducts more than 10,000 consultations a year and spends just eight minutes with each patient. Not a lot of time with patients – so absolutely no time whatsoever for commissioning (and procuring) services – taking aside the time and effort required to create, shape and manage local health markets comprising a mix of public sector, private sector and third sector, all of whom will want to create, shape and manage the perspective of their local commissioner (GP).

    Doctors want a major reform of the existing GP contract because they want any new contracts to reduce the amount of bureaucracy and administration they face, and to define their roles and responsibilities more clearly. Sounds familiar?

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