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”
“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.