GPs are doctors, not accountants

There is little evidence that GPs will be better at commissioning. Why not leave them to do what they're trained to do?
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The health secretary, Andrew Lansley, plans to give GPs responsibility for commissioning £80bn of local health services. Photograph: Martin Godwin

Andrew Lansley's white paper is being heralded as the biggest shakeup of the NHS since its creation in 1948. Having been a GP for 20 years, I feel as though I've experienced one of these "biggest shakeups since 1948" at least once every couple of years, so I'm generally quite sanguine about them. However, this one sounds like it could force me into a role that I'm unqualified and possibly unwilling to do.

Lansley's key aims for primary care are to save £1bn in management costs and force GPs to take responsibility for commissioning £80bn of local health services. By 2013, 500 "consortiums" of GPs will be distributing this money, with each consortium having an "accountability officer" to control big spenders who shell out for expensive drugs or make too many referrals. A new independent health board will ensure minimum standards are upheld.

The BMA is waiting to see all the details before commenting, and has blandly said: "It is important that any new initiatives have the interests of patients at their heart and that they are properly funded. We do live in tough economic times, but we must make sure that doctors, working together in groups, are given the necessary resources to implement any reforms properly."

GPs do know local needs best, as Chris Ham, the chief executive of the King's Fund thinktank has pointed out. Lansley says the proposals will "empower" doctors and tackle the "frustrating" bureaucracy which plagues the health service. The underlying reason for the change is to save money, but it is not clear why GP consortiums will be better at imposing cuts than primary care trusts. Furthermore, savings are not easy to calculate and will have to include redundancy packages to the managers and salaries for the newly created accountability officers. Lansley believes that encouraging a freer market in services, potentially from private providers, will drive up standards.

But do GPs really want to get involved? There's to be no let up, rightly, in seeing patients face to face and dealing with individuals' problems. At the moment, I attend a commissioning group meeting four times a year. It is dominated by a few individuals who have a strong agenda. Most participants eat their sandwiches in silence, nod off and appear to have little understanding of, or interest in, proceedings. The responsibility involved in commissioning is huge and the training nonexistent. It doesn't appear on the medical school curriculum: I've never been sent on or offered a course and can't read a balance sheet. Why would anyone want me to be responsible for complex budgetary decisions?

Where is the evidence that this model will work? A report by the Civitas thinktank has said there is little evidence that GPs will be better than the current system and has warned that the restructuring could set the NHS back by three years.

Moreover, the Treasury is apparently worried about giving so much money to GP commissioning. Experience from the US has shown poor management can lead to bankruptcies. Service providers can be left unpaid. US commissioning doctors have sometimes taken risky financial decisions or been unable to control spending.

It seems to me that there have been some very tangible benefits from the investment in the NHS in the past decade – the two-week wait for cancer referrals, much shorter waiting times and the ability for GPs to refer to a range of private providers. And although today's heartening cancer survival rate figures don't necessarily relate directly to the more recent financial investment, it is certainly a sign that the NHS is delivering better healthcare than it used to.

Belts must be tightened, money saved, waste eliminated. We all know that. But why give so much responsibility to so few with so little experience? Why not leave GPs to do what we're trained to do, ask us for clinical advice and leave the balance sheets to those who know which way up to hold them?

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