"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Thursday, 26 August 2010

GP Commissioning may cause a £2bn deficit

Sally Gainsbury from the Health Service Journal has been doing some excellent work trying to find out the consequences of GP commissioning. In the Health Service Journal today she has published an analysis of her work (available here, but you need a subscription to access it).

The main points are that the previous government trialled GP commissioning with a programme called Practice Based Commissioning. PBC is not exactly the same as GP commissioning because the GPs were given "indicative" budgets meaning that there would be no negative effects on the practice if they overspent. The study was on data of 3 years of financial returns for 33 consortia (2,000 GP practices or a quarter of all practices in England).

The results were that in total the PBC consortia overspent by 2.5% or £289m, with some 25% of consortia overspending by 5%.
Of the 159 consortia overspending, 47 did so by more than 5 per cent and 12 did so by more than 10 per cent. Five consortia overspent by 20 per cent or more.
If these results are applied across England then the GP Commissioning Consortia will overspend by £2bn. When asked about what causes the overspend Sally Gainsbury said that it was caused by GPs referring "sending more patients than they were profiled to hospital". In other words, they had too many sick patients who needed treatment.

The Department of Health responded to this study with the very unprofessional response of "nonsense". They point out that since PBC did not have the "stick" of overspends affecting them negatively there was no incentive not to overspend. This is a real admission that the whole point of GP commissioning is to force GPs to ration healthcare and so transfer the blame from the government to GPs. At this point I should mention White Paper section 5.14:
"the government will not bail out commissioners who fail"
In other words, the deficit from the overspend is your responsibility. The only way that a GP can prevent such overspends is to refer fewer patients and to do this on financial grounds only. GPs will ration healthcare, and will be seem by their patients as rationing healthcare. I do hope that those GPs who are enthusiastic about GP commissioning pay more attention to this: it will only lead to patients hating GPs.

Sally was interviewed on the Radio 4 Today programme this morning at the ungodly hour of ten to six. Luckily you can listen to the interview on iPlayer (listen here the interview is at 51m24s).

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