Dr Phil Hammond, broadcaster and sessional GP in Bristol

Do GP commissioners have the nerve to invest in the best?

Is Andrew Lansley the new Frank Dobson? It is a question raised in the Health Service Journal by Michael White, the political journalist.1 Admittedly, Mr White was at the Labour conference where the knives were out for Lansley, suggesting his reforms are taking the NHS in the wrong direction and that he’ll soon share the same fate as Dobson, the incumbent health secretary who Blair quickly dispatched for pointing in the wrong direction.

Andy Burnham, former health secretary and currently an aggressive shadow, has been particularly vocal in his beliefs that Lansley may undo all Labour’s good work by axing SHAs, PCTs, and a sack full of quangos. But we now move onto the Tory conference where it’s Lansley’s chance to get his own back. I’m chairing a meeting where Lansley is speaking on how to prevent another Mid Staffs disaster.

But the question is, how did Labour (with a hundred billion a year going into the NHS, supposedly world-class commissioning, and an enormous scrutinising bureaucracy focused on ensuring quality, safety, accountability, and patients’ rights) fail to spot such systemic poor care leading to so many avoidable deaths? The Bristol Heart Inquiry, which I had a hand in, concluded that the avoidable death toll was in the mid-thirties.2 In Mid Staffs, it may run into many hundreds; I spoke to a leading health barrister who described it as corporate manslaughter.

So what does all this mean for GPs? On a personal level we have a duty of care for each of our patients and, theoretically, if the hospital we refer our patients to, delivers substandard care we could be held to account. Pre-Labour, GPs had far more control over who we referred to. Sometimes we matched patients to consultants we knew were experts in the field, or particularly suited to our patients, at other times we may have referred to a friend or ‘a good chap’ without having much idea about their expertise. But the advent of choose and book, independent sector treatment centres contracts, and enforced referral management systems removed much of the power we had to refer a patient where we thought best. Often we have no idea where our patients end up. In such a system, it would be harsh to hold a GP accountable for the poor hospital care one of his patients receives.

But this will all change with GP commissioning and GP consortia. In the past, too much commissioning was done on the basis of cost; hard questions about safety and quality were ignored and bad practice, done on the cheap, was not routed out. You can understand in part why Mid Staffs happened—transient health secretary John Reid spent all the money chasing targets and agreeing both the GP and consultant contracts, leaving Patricia Hewitt saddled with debt and having to impose draconian cost cutting. Balancing the books became the only game in town to the extent that understaffing and inhumane patient care were both tolerated and ignored. Now we’re faced with another fierce round of cost containment and the omens for preventing another disaster don’t look good.

The hope is that GP commissioners will demand quality and expose poor practice. When stories filter back to us about patients receiving substandard care, we have to act and investigate, and if necessary suspend or withdraw commissioning until we are satisfied that the service we are buying for patients is both safe and sustainable. It’s a tough ask, and it also means we have to bring under performing GPs into line too. Never mind the complexities and technicalities of commissioning. The key question is: Do GPs have the balls to decommission the bad care to release funds to invest in the best? And don’t forget to consult the public too. Good luck!

For Phil Hammond’s blogs, books and tour dates, go to:

  1. White M. ‘The pre-election death tax row continues to reverberate.’ HSJ 2010; 30 September: 10.
  2. www.bristol-inquiry.org.uk/index.htm. G

Please login to rate this article, view others comments or make your own.