The government should reduce the pace of its health reforms to ensure that GPs feel comfortable in their new role. Plans to give GPs responsibility for NHS commissioning are at an early stage, but the interviews that Policy Exchange has conducted with GPs show that already some new and innovative proposals are emerging. If their plans are realised then patients will see real benefits.
Success will take time, though. The government will need to build up solid data on what works so that there is a body of evidence available for GPs to draw on. While some GPs are showing innovation and enthusiasm, others are taking part so reluctantly in the new scheme that they are likely to end up replicating the existing model rather than creating the new and innovative system the government desires.
Some particular issues which the government will need to focus on include: not abolishing Primary Care Trusts too quickly; ending a culture of micromanagement; and ensuring that GPs can access the external support they need. Primary Care Trusts are struggling to deal with the transition because good staff are increasingly leaving, knowing their organisations are set to be abolished in two years’ time. Equally, many GPs are worried about the size of the new Commissioning Board and whether a culture of bureaucracy is really ending. Both private firms and social enterprises which might support GPs are concerned that there has been little clarity regarding the role they will play in the new system. If a framework is not put in place soon then there is a danger that companies might leave the market and vital skills could be lost.
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.
Eve Norridge is the author of a new Policy Exchange report, Implementing GP commissioning . She is an expert on health and social care policy, and a former policy adviser at the Treasury.
