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RCGP Chair: quality premium is ‘unethical’

25 October 2011

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The chair of the Royal College of GPs (RCGP) has said the government’s proposals to hand GPs performance-related bonuses for commissioning is “unethical”.

Dr Clare Gerada’s comments follow her speech to the RCGP annual conference in Liverpool last week, in which she urged GPs to reject the “encroachment of the market”.

In the speech, the doctors’ leader said health reforms meant that GPs would “have to choose between the best interests of our patients and those of the commissioning group’s purse.”

She added: “To make matters worse, we’ll also be rewarded for staying on budget and not spending money on, for example, restoring that child’s hearing. It goes by that quaint title the ‘quality premium’. Now that’s what I call a perverse incentive.”

Speaking exclusively to Management in Practice, Dr Gerada (pictured) was asked whether she agreed with the BMA’s GPC Chair Dr Laurence Buckman, who has described the quality premium as “disgracefully unethical”.

“I think it is unethical,” Dr Gerada said. “This is about getting a reward for a behaviour that may not be in the patient’s best interests. It will perversely affect the way we interact with our patients, it just will. And the patients rightly will be worried.

“The patient has to trust their GP to make a decision in their best interests and that’s how the NHS has worked for ages and that’s why it’s so good.”

In her RCGP conference speech, Dr Gerada said GPs need to ensure that “the commissioning agenda isn’t allowed to compromise the relationship with a patient in front of us.”

She encouraged a “revolution in values”, calling on delegates to “get the actuaries, the risk adjusters and the shareholders out of the health service, and put clinicians back in charge of it.”

She added: “And then we need to bring in management staff to advise us and to assist us – staff who are truly committed to the values of the NHS.”

Dr Gerada pointed to evidence suggesting market-driven health services can lead to escalating costs and reduced quality.

“Let’s remind ourselves that the biggest health market in the world – the US – has achieved that remarkable double-whammy of having the most expensive system in the world and the greatest health inequalities,” she said.

Speaking to MiP, Dr Gerada said she did not want to “scaremonger” by suggesting that NHS reforms would lead the NHS to a more US-style health service. However, she did compare the emerging UK structures with those of the US.

“CCGs are like HMOs (US health maintenance organisations),” she said. “If you think about it the NHS Commissioning Board is essentially the insurer, it is actually handing out resources to membership groups, which are CCGs.”

Your comments (terms and conditions apply):

“I agree with Dr Gerada completely. GPs are trained to be clinicians and that is who they should be allowed to stay as. There are real concerns about the quality of commissioning the CCGs will provide and if this will be in the best interest of the patient. By handing out quality premiums that seems difficult, for the tendency will always be to go for the cheapest drug and refer minimally. Also the membership of the CCGs must be open to independent audit, esp membership to the governing boards. There is a danger of them becoming clubs, in the absence of transparent rules for election and monitoring of the rules. It is not uncommon for the members of the board to “bag” important projects/ services to be commissioned leaving others out in the cold. Are we creating a “them” and “us” once again. Are the CCGs profit making enterprises for a few GPs whilst the others simply amble along following their “directives”. Is CCG the new name for the erstwhile PCTs? And what of the additional workload on the GPs, and its effect on the quality of patient consultation time on offer?” – Rekha Vijayshankar, SE England