King’s Fund warns of GP commissioning risks

Government plans to hand GPs powers over health commissioning will hinder efforts to improve emergency services, the King’s Fund has warned.

In a report, Reconfiguring hospital services: lessons from Southeast London, published today, the health policy think-tank said the switch to GP commissioning would also damage improvement in ‘network’ services such as cancer, cardiac, stroke and renal care.

The report draws on the experience of bringing together four acute hospital trust with financial problems.

It said ‘strong commissioning of emergency and network services across a large catchment area is necessary to bring about major improvements in patient outcomes’.

Individual primary care trusts had proved too small to do this, even when they collaborated, and ‘even smaller GP consortia will further weaken levers to bring about improvement across trust boundaries’.

This was because GP consortia ‘would have even less expertise and commissioning experience than PCTs’ and so were unlikely to be able to effectively plan for improved non-elective and emergency services.

‘The new NHS Commissioning Board will need to be given the statutory powers and capability to [drive improvement] effectively,’ the report said.

Financially troubled trusts might be taken over by foundation trusts but this would remain ‘a purely theoretical option’ unless the Department of Health provided transition funding for one-off restructuring cost and to refinance legacy debt.

‘The net cost of doing so is likely to be much less than the cost of continuing to fund deficits of financially challenged trusts so that they can continue providing sub-standard care until they fail and then picking up the pieces,’ it noted.

A Department of Health spokesman said: ‘There is positive evidence from across the world about the benefits of clinically-led commissioning.’

‘Giving doctors and nurses the freedom to design services around patients will deliver better outcomes, improved patient experience, and more efficient management of NHS resources.’

But Len McCluskey, general secretary of the Unite trade union, said: ‘The evidence is mounting at an alarming rate from respected health organisations that the so-called reforms outlined in the Health and Social Care Bill are ill-judged and badly thought out.’