Interview: New GP leader condemns PM's A&E plan

Maureen Baker also used an interview with HSJ to express reservations about the government’s proposal to identify named GPs as “accountable clinicians” for patients.

David Cameron announced last month that £250m would be available annually both this and the subsequent financial year. He said: “The additional funding will go to hospitals where the pressure will be greatest, with a focus on practical measures that relieve pinch points in local services.”

The prime minister’s initiative follows severe A&E performance problems early this year. The DH is currently deciding, with other national bodies, where and how the funds should be used to reduce pressure this winter. An announcement is expected imminently, and is likely to direct some funds to, for example, social care and step-down services, as well as hospitals.

Dr Baker, who will succeed Clare Gerada as RCGP chair in November, criticised the “allocation of £500m to failing A&E departments”, and said the money would make a much bigger difference and improve overall efficiency if invested in primary care. “[£500m] is almost 10 per cent of our entire budget for general practice,” she said.

She described the decision as “voodoo med-economics” and said: “It’s the wrong use of the wrong money going to the wrong parts of the system.”

The said the policy, which won widespread media coverage, reflected “priorities in advance of a forthcoming general election”.

“If there was a much more strategic consideration about which parts of the service we need to invest in for the benefit of the whole then I don’t think these sorts of allocations would happen,” Dr Baker said. “You can just keep throwing money at the acute sector and they will just keep soaking it up and wanting more and more.”

Accountable clinician

Dr Baker also expressed reservations about the proposal put forward by Jeremy Hunt in July to mandate that frail older patients receiving out of hospital care have a single “named clinician” – likely to be a GP – accountable for their care. The health secretary is currently consulting on plans and is expected to announce further details, including how it would be implemented, later in the year.

Dr Baker said she needed to hear more “clarity about the concept”. She said: “It sounds a bit more of a political point to make rather than it actually being meaningful, but maybe if I understood more about his actual intent, it might sound more reasonable.” She said it was “a bit disturbing” that the policy may “tend not to value the input of the team… if it’s always the GP that has the accountability that doesn’t value enough the skills and input of different professionals”.

Federations

Dr Baker spoke to HSJ as her college launched a new push to promote the grouping of GP practices into larger groups of networks, often known as federations. It follows NHS England last month highlighting federations as one way of expanding and increasing the efficiency and quality of primary care services.

Dr Baker, who has developed the concept of federations in recent years with other RCGP leaders, said she hoped it could now carry out a “stocktake” of their development and provide guidance and support.

She said federations should be more widespread. Although for some practices “the way they are [already] working is probably the best model”, in some cases networking could bring about “drive to create change, enthusiasm and buy in”.

While federations are one model of linking GP practices, other methods include takeovers by healthcare firms, whether these are relatively small GP-led organisations or larger companies such as Care UK or Virgin Health.

Dr Baker said, although there were risks, she was not against such models. She said: “I don’t have an ideology about it. I believe in the NHS, free at the point of care, and normally that’s probably best delivered with the models we have.

“However, if a commercial organisation is able to add value then I don’t myself automatically rule that out. What I’d be concerned about is the loss leader ethos – commercial organisations coming in to work with practices, but with a view that when they’ve got everyone on board to then drive the service for profit as opposed to for patient benefit.”