Local NHS bodies show lack of vision

Primary Care Organisations, responsible for running the NHS at local level, have in some areas failed to grasp the opportunities given to them in the new national GP contract and displayed instead a timid short-termism, GP leader Dr John Chisholm told the annual conference of family doctors today (Thurs 17 June 2004).

In a speech to the Annual Local Medical Committees Conference in which he announced that he was standing down as chairman of the BMA's General Practitioners Committee (GPC), Dr Chisholm criticised the failure of strategic vision on the part of some Primary Care Organisations. He has been GPC chairman for seven years, latterly overseeing the negotiations for the new contract and implementing it.

He said: "The contract gives enormous opportunities for Primary Care Organisations to expand and develop primary care, to reform emergency care, to improve chronic disease management, to reconfigure services, to shift services from secondary to primary care, to take pressure off the hospital service, to reduce outpatient referrals and emergency admissions to hospitals. The failure to grasp those opportunities has been unsatisfactory and unacceptable."

Primary Care Trusts and their counterparts in Scotland, Wales and Northern Ireland have been given money to spend on extra services for patients with a minimum spending "floor" to ensure the money is used for primary care enhanced services.

Dr Chisholm said: "One of the greatest causes of anger and disillusionment has been the failure of many Primary Care Organisations to commission sufficient practice-based enhanced services. The timid short-termism of some PCOs, seeing the enhanced services expenditure floor more as a ceiling …must be overcome."

The new GP contract has a sound evidence base and delivers what doctors said they wanted: the ability to control workload, better pay and pensions, flexibility and increased investment. He urged GPs to be positive and proactive, constructive and innovative.

Research showed that a strong primary care system led directly to better health outcomes for patients, said Dr Chisholm. He spelt out the way that delivering the quality indicators in the new contract would reduce the number of heart attacks and strokes and said:"That is the health gain you will achieve for your patients in your practices – a record to be proud of."

There were some problems with the new contract, he said. The Governments' failure to invest sufficient money in the core payments – the global sum – meant that a great many GP practices were dependent on the Minimum Practice Income Guarantee (MPIG), introduced to make sure no practice would lose money because of the contractual changes. Additional money comes into practices from other sources such as the Quality and Outcomes Framework, but the widespread use of the MPIG meant many practices "are still in part locked into historic funding inequities". The intended redistributive effect of the contract's allocation formula was limited because of this, he said.

Dr Chisholm told GPs a wonderful future lay ahead, but for him the time had come for change. When the GPC holds its annual election for chairman in July, he will not be standing. "Chairing the GPC has been an enormous privilege, particularly at a time when my team and I have had such an opportunity to achieve major changes for our profession." He told the 400 GPs at the LMC conference: "We should celebrate the magic, the mystery and the joy of general practice. Patients trust their GPs. GPs deserve that trust. You have enormous value to give to your patients – working in partnership with them to give them better health. You have much to be proud of."

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