NHS shakeup could set patients against their GPs, warns report

Bonuses for doctors may alienate public says thinktank while Nuffield Trust also voices fears over hospital choice

The biggest shakeup of the NHS since its creation could turn patients against GPs because doctors are likely to start receiving “unpalatable” cash bonuses, an influential health thinktank warns today.

Giving income incentives to GPs, whose average salary is already £105,300, runs the risk of a backlash from patients, who may perceive that money meant for healthcare is enriching doctors at the expense of the treatment that sick people need, according to the Nuffield Trust.

The new consortiums – groups of GPs who will commission healthcare – could also end up alienating people if they offer doctors financial incentives not to send too many patients to hospital, it adds.

The warning comes in a new report by the thinktank, which raises concerns about potential tensions emerging in family doctors’ relationships with their patients once the new era of GP-led commissioning starts in England in 2013, handing GPs £80bn to spend on treatment.

The NHS needs to learn important lessons from the US, where for 20 years groups of doctors have been working in ways similar to how the future GP consortiums will operate, it says.

Nuffield Trust researchers found that income incentives were used routinely by the four groups of doctors they studied in California to reward them for delivering the best possible care, and concluded that similar incentives will be needed in the NHS after 2013 to encourage family doctors.

Their study states: “In the context of GP commissioning, the question of how incentives should be used has not been resolved.

“The possibility of redirecting savings from efficient care to GP private incomes is controversial and could be unpalatable to the public.

“It is, however, likely that there will need to be some sort of benefit for GPs to perform well.”

Limiting the number of patients who are sent to a hospital for investigation or treatment could lead patients to ask whether they have been denied care in order to earn doctors money.

“If GP consortia attempt to link financial incentives directly to rates of referrals into secondary care [hospitals] or specialist advice at an individual GP level, this could backfire, with patients, GPs and the media making common cause against GP leaders,” the report adds.

The study raises fresh concern about the government’s NHS shakeup, details of which will be laid out when it publishes the health and social care bill this afternoon.

Whitehall sources say the radical and complex nature of the plans means the bill will be five times longer than any previous health legislation – including the 1946 act that established the NHS.

Dr Clare Gerada, chair of the Royal College of GPs, raised similar concerns recently when she said patients could end up demonstrating outside doctors’ surgeries, demanding that their local GP consortium should provide a particular cancer drug, for example.

Gerada said that patients could argue that “you’ve got a nice BMW but you will not allow me to have this cytotoxic drug that will give me three more months of life”.

She fears that Health Secretary Andrew Lansley’s decision to transfer responsibility for deciding which treatments represent value for money from the National Institute for Health and Clinical Excellence to GP consortiums will lead to conflict.

The Patients Association said it was “very concerned” that the trust between the public and doctors could be affected. “Patients may wonder whether they will be referred to the best services, and not the hospital which the GP may see as making money for him,” said Katherine Murphy, its chief executive.

“Could the healthcare needs of some patients be compromised because GPs are now holding the pursestrings and are more concerned with the consortium’s bottom line than the patient’s needs?”

The report also warns that patients could lose the right to choose which hospital they are treated in – a central plank of NHS policy since the early 2000s – because consortiums are likely to have contracts with “preferred” hospitals, but not necessarily every NHS facility in the area.

Meanwhile, in another detailed critique of the plans, Gordon Brown’s former head of public service transformation says today that it will be “a modern miracle” if the NHS reforms deliver the benefits that ministers have claimed, because the risks involved have been underestimated or ignored.

In an analysis for Civitas, the right-of-centre thinktank, Sir David Varney warns that scrapping England’s 152 primary care trusts in order to make £20bn of efficiency savings is highly risky at a time when the NHS is meant to be delivering unprecedented productivity gains.

Varney writes that Lansley’s white paper ignores the risks to the NHS that the upheaval involves, “appears to believe that noble ends will suffice” and “pays little attention to the history of NHS re-organisations, and nor does it have much time for reflection on lessons learnt”.

Varney is an ex-chairman of HM Revenue and Customs who used to run British Gas and also chaired the Barking, Havering and Redbridge NHS University Hospitals Trust in Essex last year.