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'Risky' reforms get support

'Risky' reforms get support

Events news
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The coalition's health reforms are the "most risky thing anyone has ever tried with the NHS", delegates at a GP Business conference were told.

Speaking on the same day that Health Secretary Andrew Lansley told the House of Commons that "significant changes" would be made to the Health Bill (14 June) as a result of the Future Forum's findings, Dr Robert Varnam, a Manchester GP and a member of the Forum, pledged his support for plans but underlined how radical they were.

The coalition's health reforms are the "most risky thing anyone has ever tried with the NHS", delegates at a GP Business conference were told.

Speaking on the same day that Health Secretary Andrew Lansley told the House of Commons that "significant changes" would be made to the Health Bill (14 June) as a result of the Future Forum's findings, Dr Robert Varnam, a Manchester GP and a member of the Forum, pledged his support for plans but underlined how radical they were.

More than 450 GPs and practice managers who attended the event in Manchester heard keynote speaker Dr Varnam defend the listening exercise as "apolitical" in the way it had been conducted, but concede that the government's Health Bill is "possibly the most risky thing anyone's ever tried with the NHS".

He was adamant, however, in his support for the reforms, insisting that "if you want different results, you have to change the system", quoting Albert Einstein's cliché that the definition of insanity is doing the same thing over and over again and expecting different results.

Dr Varnam argued that by bringing commissioning "right into the heart of the practice", the government's plan could allow for real change and improvement in patient outcomes.

Dr Varnam, also the Royal College of GPs' Clinical Lead for Commissioning, told delegates that practices will no longer be "cogs in a machine" following directions, but their new commissioning role means they will be "guardians of the health service".

As such, he said, GPs now have a responsibility to get involved and steer the process, but at the same time work together with other clinicians – as indicated by the government's announcement – in a new era of partnership working.
"We're going to have to share and to collaborate [with colleagues across the health service] like never before," he said.

He acknowledged that there has been "a lot of uncertainty about where we're heading" but, referring to the Future Forum report, added: "We have at least got some direction now."
Dr Varnam insisted that the NHS Future Forum report accurately reflected the issues raised in its listening exercise.

"What's come out is pretty much a summary of what everyone's been saying for quite a long time," he said. "Concerns about the pace of change, about imposing change from the centre versus localism, about how you do governance and who should have representation – I think these have been themes that have been around for quite a long time and are crystallised in this report."

The exercise had been a "big thing", he added, pointing out that more than 200 listening events have taken place attended by approximately 7,000 people, with a further 25,000 sending views by email and 4,000 sending questionnaire or website responses.

Following Dr Varnam's opening address was a presentation from Joe Rafferty, Director of Commissioning Development at NHS North West.

Having led the implementation of commissioning reform across the region, Mr Rafferty gave an authoritative update on the progress of the pathfinder programme across England (covering 87% of the country's patient population at the time of going to press), the main areas of competence expected of commissioning groups and the support available.

He insisted that he was in no way pre-empting the government's yet-to-be-announced response to the Future Forum report, he said that the two critical issues it had raised were the pace of change (the revised bill would "almost certainly [allow for] a more permissive system," he said) and the reduced emphasis on GPs in both the name and operation of the commissioning process.

Above and beyond the policy announcements, however, Mr Rafferty declared the most "pressing need" facing the health service would be to get its finances in order to help achieve the 'Nicholson challenge' of finding £20bn of efficiency savings by 2014. Mr Rafferty's advice to all commissioning groups was, he said, to "grip its financial situation".

Delegates were later advised just how to do that in separate expert presentations. Deborah Wood, Vice Chair of specialist medical accountants association AISMA, outlined profit-making opportunities arising from commissioning changes that lie outside the core NHS contract, as well as the potential financial implications of changes to the core GMS contract in 2011/12.

Elsewhere, expert medical accountants advised on current medical funding issues affecting general practice as part of a dedicated training stream offering more in-depth seminars.

In another speaker presentation, Dr Mike Warburton, who helped draft the new patient participation direct enhanced service (DES) while at the Department of Health, gave an overview of the changes to the GMS contract this year, focusing on the changing indicators of the Quality and Outcomes Framework (QOF) and the new quality and productivity drivers, including how practices can best approach delivering the new patient-focused DES.

With so much focus on the development of commissioning groups – both in name and function – it was fitting that delegates heard from Nicola Baker, Chief Officer of Stockport Managed Care, one of the first national commissioning group pathfinders. Set up in 2007 by 52 practices in Stockport, the organisation was one of the very first of its kind in the country.

Mrs Baker was therefore well placed to advise on a delivery plan for commissioning groups, and outlined critical challenges facing GPs, such as obtaining value from better and less variable primary care services, "re-engineering" clinical programmes and pathways and holding the supply system to account. As she told delegates: "No GP will be able to completely divorce themselves from the changes ahead. However, every GP has a role to play."

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