Family Doctor Association Position Statement on NHS Bill
The Family Doctor Association, an educational charity representing over 1000 member practices in the UK, supports Clinically Led Commissioning as introduced throughout England by the NHS Health and Social Care Bill. The Family Doctor Association has been engaging with government since the White Paper was published to put forward the need for continuity of care and a patient focus in the way the policy is implemented.
The Family Doctor Association is not an uncritical champion of this Bill. We have been working with government to improve those parts which are valuable for patients and which encourage closer working relationships between practices and between health and social care organisations and patient groups. The Association continues to work to mitigate those parts of the bill which we find unhelpful.
There are some aspects of the Bill with which we disagree. In particular, the unfettered power of the NHS Commissioning Board over GP practices must be limited by Regulations laid subsequent to the passage of the Bill, despite the assurances received that the powers will not be used to excess.
Previous attempts to introduce Clinically Led Commissioning – fundholding, World Class Commissioning, Practice Based Commissioning - have all failed either by segmenting general practice into those which are allowed to commission and those which are not, or by failure to attract enough members to make a difference to patient care.
The Bill forces the issue and makes Clinically Led Commissioning the only game in town. For the first time, all the clinicians in each area can work together to provide clinical leadership in decision making on local priorities. It puts clinicians in the driving seat of locally based and locally sensitive health services which involve not just GPs but also local consultants, public health doctors, local councillors and local people in decisions about the provision of health care in each area.
There are those who say that the Bill is unnecessary and that Clinically Led Commissioning and clinical leadership could have been introduced without the Bill. This has been proven to be untrue as already explained. It needs a Big Bang to change the direction of the health service. Without primary legislation, the top-heavy administration of the SHAs and PCTs would continue. With the Bill, administrative overhead costs will be reduced by at least 50%.
We wish to retain those good NHS managers who can put the wishes of the clinical commissioners into practice and good Clinical Commissioning Groups (CCGs) will need good Commissioning Support Organisations behind them – but structured imaginatively and not just reinventing PCTs, which would be a sign of failure. As an example, the CCGs in the mid-West of the country have formed a CSO covering Buckinghamshire, Berkshire, Oxfordshire, Gloucestershire and Swindon to do their bidding.
Evidence of useful change in the service received by patients is emerging all over the country as CCGs gear up and provide real clinical leadership locally. Without the impetus of the Bill, none of this would have happened.
We know that changes in general practice can have a dramatic influence on population health. With the introduction of the QOF (Quality and Outcomes Framework) in 2004, practices focussed their attention on primary prevention of heart disease and in blood pressure control and smoking minimisation. Recently published research shows a 33% drop in the numbers of those experiencing a heart attack – a success which can largely be attributed to the work of GPs and their teams..
Contact: Dr Peter Swinyard on 01706 620 920 or firstname.lastname@example.org
The Family Doctor Association, the national voice of frontline GPs, founded in 1985, is one of the five major GP organisations the Department of Health consults on NHS changes. FDA members are GPs and practices that offer their patients the benefits of continuity of care; the cornerstone of UK general practice. Continuity of care benefits patients, improves health outcomes and saves the NHS money. The FDA is a registered educational charity no. 299871.