There is no doubt that the recent health White Paper is one of the biggest things to hit general practice and, in fact, the NHS, in years.
While many of the headlines have focused on the impact the changes will have on GPs in terms of them commissioning services, the plans have far reaching implications on other aspects of general practice. For a start, it looks like this is the end of the road for PMS.
As the document says: ‘the Department will seek over time to establish a single contractual and funding model to promote quality improvement…’ And seeing as PCTs, with whom PMS practices hold their contracts are to be abolished from 2013 and all practices will hold contracts with the new NHS Commissioning Board, one new contract seems certain.
There are many unanswered questions about what all this will actually mean in practice, but we can probably expect protracted negotiations between the government and the GPC over the coming months. As a union, the BMA is no pushover, and surely it will demand extra funds to take on commissioning. Various commentators have suggested that there is no more money in the pot for this, but if efficiencies can be made elsewhere in the system this money may be made available to help fund the White Paper roll out.
Mr Lansley had previously claimed his plans for GP commissioning would not involve wholesale renegotiation the existing contract. But the amount of change the White Paper proposes makes it difficult to see how this will be the case. If we are talking about a new contract, will the profession have the chance to vote on the outcome of the DoH/GPC discussions as it has done in the past? Mr Lansley has presented his plans a a fait accompli, which suggests not.
As GP has previously written, the push for GP commissioning in England also heralds the end of the UK-wide deal. Devolution has already lead to huge differences in healthcare in each of the four UK countries, Mr Lansley’s plans will push these differences even further.
What do GPs in Scotland, Wales and Northern Ireland think about all of this? Are you envious of your colleagues in England and the new powers they will have? Or are you relieved that all this upheaval is not happening to you?
Wherever you practise, you can tell us what you think about the White Paper by completing our online survey.
