Councils welcome public health role but fear GPs will ignore them

15 Jul 10
A landmark NHS white paper has proposed giving local authorities new responsibilities for public health – but there are widespread concerns that councils' voices will be ignored
By David Williams

16 July 2010

A landmark NHS white paper has proposed giving local authorities new responsibilities for public health – but there are widespread concerns that councils’ voices will be ignored.

Equity and excellence: liberating the NHS, published on July 12 by Health Secretary Andrew Lansley, also included controversial plans to put consortiums of GPs in charge of commissioning. Clinicians would be responsible for around £80bn a year, or four-fifths of the health service budget. This would lead to the scrapping of primary care trusts and strategic health authorities.

Lansley’s proposals, which only affect England, would give councils control of the £4bn public health budget, which is to be ring-fenced. Local government would also be given a role overseeing local NHS strategy and partnership working between the health agencies and other local bodies.

But commentators are already worried that councils will be effectively powerless over commissioner-GPs.

Robin Miller, senior fellow at the University of Birmingham’s Health Service Management Centre, told Public Finance that it was ‘good and proper’ to have a single body in charge of school meals, leisure centres, social care and public health.

But, he said: ‘Although [councils are] responsible for ensuring that commissioning is joined up, they don’t have any influence over what is commissioned. They’ve got a responsibility but no authority to do much about that responsibility.’

Miller explained that tensions could arise between councils and GPs over whether to spend money on clinical treatments or services that  might improve public health, such as subsidised access to sports facilities. Elsewhere, commissioners deciding to cut down on health visitors for new mothers and spend more on hip operations could have an adverse impact on a council’s children’s services, he said.

James Hulme, head of communications at the New Local Government Network, went further. ‘You have got to question why GPs would take any notice of councils under these reforms,’ he said. ‘There is a danger GPs would ignore those voices.’

Hulme called the reforms ‘a regressive step’, and said that in placing most power in the hands of GPs, the white paper pushes health further out of the reach of local government.

Janet Sillett, policy analyst at the Local Government Information Unit, said she was confident that councils would be able to take on the new responsibilities, but added that they would place new burdens on already strained budgets.

‘Councils will have to establish new relationships and that will be difficult – the new framework will be worth the aggro if it actually gives more potential for flexibility in terms of budgets. If not, it’s bad news.’

Sillett cautioned that GPs were culturally more independent than PCTs, adding it was critical that they understood health inequalities, and were willing to pool budgets.

Dr Steve Field, chair of the Royal College of GPs, told PF that family doctors would be willing to form partnerships with councils. But, he added: ‘Some constructive tension is not a harmful thing.’

Field said he was optimistic that the new arrangements would work as long as GPs weren’t ‘micro-managed by local government, instead of being micro-managed by central government.’

According to the college’s estimates, a typical GP consortium would serve a local population of around 75,000–100,000, suggesting that most bodies would be smaller than current PCTs. It will be compulsory for all GP practices to join a consortium.

Field said that many GPs were already involved in commissioning through PCTs, although some would take on new duties. Many would continue with their clinical work as they always have, he added.
Field was broadly upbeat about the proposals, saying that many doctors have been frustrated at their lack of influence on the running of the health service so far.

Lansley wants to reduce NHS managerial costs by 45%. He calculates that stripping out PCTs would contribute £1bn to the £20bn NHS savings target to be met by 2014.
See interview with Chris Ham

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