The UK’s healthcare system could be on the verge of a massive shake-up as rumours gather force that the new government intends to hand GPs control of a cash pot said to be worth around £60 billion.

In a radical move that signals a fundamental change to the status quo, primary care trusts look set to lose control over GP spending as well as managing their performance, with responsibility for purchasing to be handed over to groups of GPs instead.

Under the proposals, around 500-600 GP consortia across the country will contract directly with the incoming independent NHS board in commissioning primary care services, thereby completely cutting PCTs from the equation, according to the Health Services Journal.

The government has already announced plans for a significant cull of strategic health authorities under its wider agenda of slashing bureaucracy in the health service to cut costs, but while the DH could not confirm to PharmaTimes UK News a transfer to GP budget holding, the HSJ quotes a senior source at the Department as saying: “PCTs are screwed...They are under more threat than the strategic health authorities”.

What it does say in the government’s recent coalition document is that going forward PCTs will be responsible for public health budgets and purchasing “residual services that are best undertaken at a wider level, rather than directly by GPs”, which, the HSJ says it has been told, are likely to include aspects such as pharmacy and maternity care.

A spokesman for the DH told PharmaTimes that further detail on the government's plans for the NHS will be set out soon, but already there is growing concern over how a return to GP fund-holding will be successfully implemented at such a critical juncture for the Service.

For one, it is questionable whether GPs will actually want to bear the responsibility, particularly as many will be inexperienced commissioners and there is huge pressure on the Service to garner efficiency savings of up to £20 billion over the next few years. Also, there are questions over accountability and how such GP consortia would be managed.

Right direction?
According to a recent report by the University of Birmingham's Health Services Management Centre, giving GPs control over budgets has the potential to improve patient care and lead to better use of healthcare resources, but it urges caution “in promoting budget holding as a universal solution without regard to the capabilities of practices to manage a budget”.

Report author Professor Chris Ham, now Chief Executive of The Kings’ Fund, says handing GPs greater control of NHS budgets will significantly change the healthcare landscape, and that it is “the right policy direction but has to be very carefully implemented”.

“It is essential that appropriate leadership skills and management support are in place, that there are mechanisms to prevent financial incentives leading to under diagnosis and under treatment and that budgets are adequately adjusted for the health risks in the populations served by groups of GP commissioners,” he stressed.