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David Nicholson doubts 2012 timescale for GP commissioning role

NHS chief executive Sir David Nicholson has poured doubt over health secretary Andrew Lansley’s plans to implement GP commissioning by April 2012.

Giving the closing speech to the NHS Confederation conference in Liverpool today Sir David said he doubted the reforms would be any where near ready for full implementation by the 2012 date Mr Lansley has told officials he wants.

He said “even the most optimistic people wont say we will get this system up and running” by that time.

He said that on a scale of one to 10, even the best GP practice based commissioners were “only about a three” in terms of the quality of their commissioning.

Asked if NHS commissioning would be transferred to GPs by April 2012 he said:

“I think it’s dangerous to put a date of that kind of nature [on it].”

He said the success of the policy would depend in part on negotiations with the BMA. Naming a date by when the government wanted the system in place would only empower the BMA in their negotiating position, he said.

He confirmed the Treasury was “was concerned about financial performance” under the policy. But he added: “So am I”.

He said the NHS had “fought hard” to recover its “financial grip” since the deficits of 2005-06 and he was not going to allow that to be put in jeopardy.

He said: “I’m not going to put that financial grip at risk. Never mind the Treasury; they’ve got to get past our tests first.”

He reassured the audience the Department of Health was “absolutely alert to not being over optimistic about the time frame.” He said the discussions to establish GP budget holders would take detailed negotiations both with other government departments and the BMA.

But he described health secretary Andrew Lansley as “a man in a hurry” and said there was an “absolute determination” in the new government to that “if we are going to make change, we make it soon”

Yesterday, Mr Lansley said there was no benefit in delaying implementation.

“I have been with GPs who say they are ready to go now,” Mr Lansley said. “There is no merit in making these changes take a long time. There is every merit in knowing what we need to do and doing it quickly”

Despite throwing doubts over the timeframe involved in implementing the GP commissioning policy Sir David offered his support for its rationale.

He said that if every GP made one less blood test and referral a week the NHS would save £0.5bn in a year.

Sir David acknowledged the eventual implementation would lead to job cuts within primary care trusts.

He said he would “always tell it to you straight” and he viewed it important to “treat people with the amount of respect they deserve.”

He said the comment of an unnamed DH source who earlier this month told HSJ “PCTs are screwed” was “entirely inappropriate”.

But he said: “We need to be realistic. There is a significant management cost saving [to be made]. Some people are going to lose their jobs in this time.”

He told the conference of NHS senior managers: “Do not give people false hope”.

Asked if cuts to local authority social care budgets would mean NHS funds would need to be used to pay for social care he said that was something the NHS had to “take on the chin”.

“The most important thing here is our patients; not some Whitehall definition,” he said.

Readers' comments (35)

  • Oooh... this is going to be fun!

    Pass the popcorn, please!

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  • These sound like the words of a man who is ready to retire on full pension and not bothered about getting a peerage.

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  • Dear Mr Lansley

    I quit.

    David Nicholson OBE

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  • Lets hope he takes a few of his pets with him.

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  • 'Lets hope he takes a few of his pets with him.'

    I am sure that his 'pets' will either see the direction of travel or be put on 'special projects'....

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  • Not sure why he wants to hang on to such a useless commissioning system, which is ‘poor to mediocre’ (i.e. less than 3 out of 10) according to a health select committee report.

    Looks like we need a new NHS CEO (if one at all). The current one is living in the past rather than the future. We need a ‘can do’ CEO rather than a ‘can’t do’ CEO. Someone who is able to mobilise support and get things moving rather protect the status quo and protect their interests. Someone who can deliver change by 2012 rather than block change until 2015.

    If we continue to have blockers all the way at the top, the NHS will still be a very expensive, inefficient, and suboptimal service, delivering mediocre care and mediocre quality.

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  • This is ridiculous, the NHS CEO cannot even deliver GP commissioning in 2 years, when it was supposed to have been kicked off in 2005. He will have had a total of 7 years to deliver this and all we get is excuses for his failure to drive through PBC in the last 5 years.

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  • But who will tell Emperor Lansley that his new policy does not have even a fig leaf of credibility?

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  • Anonymous, 5.41. The reason PBC hasn't taken off is the GPs don't want to play, not because of any want of effort (or incentive to GPs) to make it work. This is why Lansley's policy is doomed.

    In any case there won't be any money left for the GP consortia to play with after the redundancy bill for half of the staff in every PCT has been met.....

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  • What I don't quite understand is why anyone thinks putting small business men in charge of the nhs commissioning budget is a good idea? Is this not privatisation ?

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  • Looks like DN is trying to force the issue. If Lansley wants to get rid of him he will have to fire him. Nicholson won't go quietly.

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  • Oh dear oh dear, here we all go again. Haven't we learnt anything over the last 20 years. It seems to me that most GPs are either interested in making loads of dosh, retiring early or going part-time, or they won't play because they are too interested in patients.
    What a complete nonsense from Lansley - did this really take him 6 years as shadow to think up? - heaven help us all.

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  • Mark Britnell for CEO ?

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  • No way to Britnall. If Lansley wanted to sack Nicholson surely he need only ask how much was spent on Mckinseys and then refer to para 4 of the NHS code of conduct which says you need to use money responsibly and hey presto. Couple that with after two years of talking about needing to make £20bn savings but Lansley arriving and there being no plan and Lansley could simply sack Nicholson. No deal. No pension. Many would regard that as justice.

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  • If Lansley doesn't fire DN then the so called reforms will amount to little moire than a change in terminology. Lansley has no choice.

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  • Ministers are (and must be) ultimately in charge of a national HS not officials, no matter how much arms length distance you put between them. Ironically Nicholson's comments on possible loss of financial grip can be seen as an attempt to save Lansley from himself (and the Treasury) when things inevitably go awry. But you shouldn't do that publicly and expect to get a deal. If this is an end game, it should be settled by Ministers in a way that sends unambiguous messages to SHAs and remuneration committees that deals are over. Not that they could be reconciled with controlling public sector pensions costs in any case.

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  • What Mr Lansley said at the conference this week made sense - GPs initiate much of the costs in the NHS, so let's put them in charge. The worrying thing is that when asked, he had absolutely no idea how they would be made accountable for their actions. He has no doubt told DoH hobgoblins to think of a way - risking the old top-down, process-driven meandering we have seen too often over the last decade!

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  • DN. Good riddance. A clear failure to influence ministers, so the first days of the new administration tie us to as much incoherence as the last. Mass exodus of senior talent, American Hmos waiting in the wings to replace them at a hugely inflated cost. Community services a total mess with assets in one direction, staff in another to consolidate the excess power of complacent monopoly acutes, and unrestricted private sector entry but no defined services or pricing.
    Lansley and DN have dismantled the existing system before there is anything to replace it at a time when the NHS energies should be focussed on delivering the greatest change in service patterns and efficiency in history. A decent CEO could have prevented all this. Well done you two, a decade of improvements undone, and a dangerous vacuum in power all at once.

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  • It is sad that this does not seem to be seen in the system as an opportunity.

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  • Could the HSJ carry out a poll on readers view on Mr Lansley's proposed changes to date, in terms of reducing costs and delivery quality of care. It may help me and others to clarify what the overall feel is for the Health Service over the next 3-5 years

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