The Royal College of General Practitioners has told the government that allowing patients a free choice of GP practice would be “damaging in terms of continuity of care, health inequalities and potentially, patient safety.”
Such a move would also “very likely threaten the viability of some practices, especially rural practices that provide a vital service to patients who are less mobile and potentially more vulnerable” to changes in service reconfiguration, the College warns, in its response to the Health White Paper: Equity and Excellence - Liberating the NHS.
The reforms will need strong monitoring for possible adverse impacts on health inequalities, the College goes on.
The GPs say they give their backing to the principle of shared decision-making with patients and to the statement: “no decision about me without me,” emphasising that the unique long-term relationship between patients and GPs must be retained in the provision of care as well as the commissioning of services.
Also, the principles of greater GP leadership and influence are “well received,” the College says, but adds that its members have expressed concerns that the scale in which changes needed to be made is not justifiable - especially in the context of cost reductions - and that the proposed scale, pace and cost of change will prove disruptive.
Some members are also concerned that the proposed changes will eventually create multiple tiers of GPs with different training and continuing professional development (CPD) requirements; several salaried GPs and locums said they had particular concerns that their contributions would not be recognised within the new structures. On the other hand, GPs - particularly those at the start of their careers – said they would welcome the opportunities for increased potential to influence services to patients and the wider community, and expect the reforms to allow more freedom for local provision of GP-led services.
While the White Paper applies to England only, the RCGP consulted its 42,000 members across the UK and internationally in drawing up its response. It found that members were concerned that the new structure would create issues for cross-border areas, particularly between England and Wales, and that the different requirements being placed on GPs in England as a result of commissioning might result in a divergence in training requirements and levels of skills and experience, it says.
- In its response to the White Paper earlier this month, the British Medical Association (BMA) warned that that positive elements of the government’s proposals, such as devolving more control to patients and frontline clinicians, plus a stronger focus on public health, were at risk from other aspects that seek to accelerate a market-based approach.
Elements of the White Paper that would encourage further competition in the NHS – such as extending choice to “any willing provider” and giving the foundation trust regulator Monitor a duty to promote competition – would risk shifting the focus onto cost rather than quality, and would undermine opportunities to work more collaboratively across primary and secondary care, the Association warned.
The White Paper includes proposals which doctors can support and would work with - such as devolving more control to patients and frontline clinicians, and a stronger focus on public health - but there is also much that would be potentially damaging, the doctors’ group warns.
“The BMA has consistently argued that clinicians should have more autonomy to shape services for their patients, but pitting them against each other in a market-based system creates waste, bureaucracy and inefficiency,” said Dr Hamish Meldrum, chairman of council at the BMA. “Doctors want to build on the founding principles of the NHS, and to maintain and improve services despite the hugely challenging financial climate. However, they can only succeed if they can work in partnership with others in a co-operative environment,” he added.