A monumental challenge for GPs

There is no doubt that Andrew Lansley's plans for the health service are radical. Shifting responsibility for marshalling £60bn of health service expenditure from statutory NHS bodies to GPs is a bold move. Opinion is divided on whether the plans will be effective. Many would agree that GPs are well placed to take on this role as they know their patients well, understand the health service and already directly influence hospital resource usage through making referrals. Others raise concerns about how motivated GPs will be to take on the role and whether they really have the necessary skills – being a good doctor does not necessarily make you a good budget manager. There are many details still to be resolved. For example how GPs will be held to account for commissioning, what happens if they overspend, will they be allowed to make a profit and whether the approach is voluntary or mandatory. No doubt the details will become clearer over the coming weeks and months. Financial challenge What has been less discussed is the transition. Whether GP-led commissioning works well or not, it will take time to put in place (probably until 2012 at the earliest) and then will probably take two to three years to bed in. In the meantime the NHS is facing the largest financial challenge it has experienced in recent memory. Although the new government has confirmed that the NHS will continue to receive above inflation funding increases, it will also continue to face cost pressures at an even higher rate due to increases in demand and costs of new drugs and technologies. Andrew Lansley has confirmed the previous government's assessment that the NHS will need to make savings of £15-20bn over the next three to five years. If the NHS does not deliver this level of efficiency and productivity gain, then by the time GP commissioning takes up the rein, the NHS could well be already in significant deficit. At which point the already tricky challenge of motivating GPs to take on this responsibility, starts to look monumental. Managing the transition So we need the current NHS systems to deliver at the same time as the new systems are being developed. Currently Primary Care Trusts (PCTs) are responsible for commissioning health services. Much rests on their shoulders. Not only do PCTs have to help to manage the transition to allow the GPs to pick up the mantle, but at the same time have to deliver probably the most complex and challenging change agenda faced by the NHS in years as their spending power effectively reduces. PCTs have faced a lot of criticism in the past – sometimes fairly, often unfairly. But right now we cannot afford for them to fail or walk away from the job. Fortunately most PCT leaders are experienced and capable, and are ready to meet these challenges. They are not afraid of change and are well placed to deliver what the new government is asking of them – a revolution in health care. Will this revolution deliver? We don't know for sure. There are many risks involved but closer working now between PCTs and GPs should help to ensure that we are all well-prepared for the financial challenges that lay ahead. The best PCT leaders are already working closely with their GP colleagues to build the foundations for a new model of clinically-led commissioning and ensure the existing system manages future financial pressures effectively. It is essential that we avoid a talent drain from PCTs over the next two years as now more than ever we need strong leadership at a local level. David Stout is director of the PCT Network, NHS Confederation