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White paper - Countdown to new NHS starts

Daniel Brookbank says GPs must plan ahead for hard budgets and the other reforms.

Daniel Brookbank: 'If you are not involved in practice-based commissioning, get into it before it is too late and start managing your budget' (Photograph: Istock)
Daniel Brookbank: 'If you are not involved in practice-based commissioning, get into it before it is too late and start managing your budget' (Photograph: Istock)

Last month's White Paper, Equity and Excellence: Liberating the NHS, has been billed as the most ambitious shake-up of the NHS since its inception.

The main thrust of the proposals is that patients will be at the centre of everything. So what should practices be thinking about and doing now to be ready for the bulk of reforms coming to us in 2012? From my perspective as a practice manager, this article describes what I think the priorities should be.

At the centre of everything we do will be our patients. They will be given the information they need to be able to make informed choices about their care.

This will mean an increase in choice for them too. They will be able to choose which hospital, which consultant and which GP they want to see. As practices, we need to be ready to provide information on the services available along with ensuring that systems such as Choose and Book have all the providers available.

Patients can select from any willing provider: this could be secondary care, new GP-led clinics or private providers.

Patients are also going to be allowed to register at any practice they choose. If they live in one place and work in another, they might prefer to register close to where they work.

This is all very well until it comes to home visits and out-of-hours care.

When out-of-hours services are commissioned we will have to ensure that cover is in place for patients who do not live locally but are registered with us. So, joint agreements with other out-of-hours providers will need to be established, along with the ability to deal with home visits.

Provider ratings
Patients are going to be given the opportunity to rate hospitals and providers, including GP surgeries. Those results will be published, probably on the internet and in your local paper.

We are going to have to ensure that we provide the best care if we do not want to fall foul of bad ratings. Customer care needs to be part of everything you do.

An organisation called Health Watch England will emerge as part of the Care Quality Commission to work with patients to ensure standards are kept at the highest level. It will operate nationally, with local authorities taking on new powers locally.

GP consortia
We need to think about this now as the early adopters will be in there and possibly cherry- picking the top-performing practices for their consortia - or, if healthcare companies, for partnering arrangements with consortia.

Eighty per cent of the entire NHS budget is coming to practices in the form of hard, 'real' budgets, and we are going to have to manage them. This means getting together with other practices and forming consortia to commission services.

If you are not involved in practice-based commissioning (PBC), get into it before it is too late and start managing your budget. We have around two years before hard budgets arrive, so two years to learn the job.

NHS Commissioning Board
Over the next few years the SHAs and the PCTs will gradually fade away. A new NHS Commissioning Board will be responsible for handing out the commissioning budget and ensuring quality and continuity of care. Local authorities will be responsible for aligning NHS services more closely with social services and local health improvement.

New relationships will have to be forged with these organisations and the new GP consortia, in the same way as relationships have developed with the PCTs.

The difference is that patients will be involved. So, if your practice has a patients' forum, give the members the White Paper to digest. More detailed information on how GP consortia will work is at healthcarerepublic.com/whitepaper

Any willing provider
Social enterprise will come to the fore, with organisations getting together to provide services. For GP consortia, this will be a great opportunity to look at new areas of working and linking up with specialist providers.

The big danger here is that all services provided will be on an 'any willing provider' basis, so the private companies will be exploding into life. They have been waiting for this moment and, in time, will look to provide GP services. Practices need to keep pace or get ahead of them: we know what our patients want and they trust us.

Opportunity and risk
GP surgeries should be looking at opportunities now: what skills and advantages do we have? What interests do we have? How can we do things better? Emergency care and out-of-hours services spring to mind.

This White Paper gives us enormous opportunities, but comes with a sting in its tail. Get it wrong and you risk losing everything; get it right and your patients could benefit from much better services and increased level of care.


1. Patients will have a much bigger say in their care.

2. The end of practice boundaries: patients will be able to choose where they go for their care.

3. 80 per cent of all budgets devolved to potentially 500 GP consortia.

4. SHAs and PCTs will be abolished.

5. New, independent NHS Commissioning Board will take control, free from government interference.

Start working now
  • Get involved now and become an 'early adopter'.
  • Start talking to other practices.
  • Organise an extra meeting with your patients' forum to get them on board and give them all copies of the White Paper to read.
  • Identify services that need to change.
  • Start to really manage your PBC budget.

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