Exclusive: GPs should seek legal advice over commissioning role - Gerada

Dr Gerada said decisions made by GPs involved in emerging commissioning groups could conflict with their duties to patients under the doctors’ professional code Good Medical Practice.

In an interview with HSJ yesterday she said emerging commissioning groups had begun making “decisions about rationing” – for example limiting some types of referrals or medicines and reallocating budgets. She said GPs “must not be involved in rationing decisions” except in an advisory capacity “at a very high level”.

Dr Gerada said there was increasingly a conflict between involvement in commissioning and professional rules. She said: “I would caution GPs about signing any document which conflicts with the General Medical Council’s Good Medical Practice. [The guidance] makes the patient – you in front of me – my first priority – not managing a budget or making ends meet.

“When GPs in practices are asked to sign documents which mean we have to stay within budget they are making that their first priority and that is going to conflict with their first priority which is to the patient.”

She said: “A lot of GPs and practices are now being asked to [agree to] keep within clinical commissioning consortia memoranda [about limiting spending or referrals]. I think they need to seek legal advice.” Dr Gerada said it was a greater issue in smaller CCGs where GPs were “closer” to decisions.

Asked about the position of the GMC, Dr Gerada said: “I suspect the GMC isn’t fully aware. None of us are fully aware, this is happening so rapidly.”

In place of local “rationing” Dr Gerada called for a major national health profession-led review to decide how much should be spent on health and what can be provided, in the model of the 2001 Wanless Report.

She reiterated strong opposition to the thrust of the Health Bill mainly because she felt it would lead to privatisation, increase running costs and “seriously fragment our national health service”.

Dr Gerada was speaking shortly after Prime Minister David Cameron had claimed in the Commons that the RCGP supported the bill.

Dr Gerada repeated support for the principle of greater clinical involvement in commissioning but, asked about GPs who supported the reforms, urged them to be “cautious”.

She said: “This is not a game anymore, this is serious stuff… and will only result in decreased professionalism, increased cost.

“Rather than GPs being in the ascendance driving healthcare change, we will instead be salaried employees of these CCGs, which will morph effortlessly into healthcare management organisations [US-style independent sector insurer-providers].”

She said: “It is my job to spend every spare minute I can to understand this agenda. I have become more and more worried as time has gone on. It’s my job as the leader of the RCGP to point these things out.”

Asked about support for the campaign against the reforms among senior managers, including NHS chief executive Sir David Nicholson, Dr Gerada indicated it had been strong.

She said: “I have a lot of people talking to me – ringing me up in confidence - including very senior people, very senior people in high places who are anxious about the Health and Social Care Bill but can’t say it in public because they are frightened for their own jobs.”

Dr Gerada also said the Health Bill had distracted from attempts to reform GPs as providers. For example, she said one of her priorities before the publication of the bill had been encouraging practices to form federated groups in order to improve services and save money. Anecdotal evidence suggests this process has slowed down, she said.

She said: “Many GP practices were already federating – then top down reform stops everybody in their tracks. Federations are the way forward – groups of practices working together sharing resources and staff but maintaining their independence.

“We can still have that if we think imaginatively…but it is more complicated because we’re removing GPs to run commissioning which means there is less time to sort out provider reform.”

Dr Gerada said she was concerned her chairmanship would be dominated by the government’s reforms and therefore was “working very hard… [to] put in train very rapidly the thing I wanted to do”. This included work on federations, starting a commission on general practice to review the profession and several projects to address health inequalities.