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Is a total loss of autonomy on the way for GPs?



The Government’s white paper for reform of the NHS in England, published last month, is an obituary for general practice. I believe that the reforms will strengthen the marketisation of the NHS, rather than restricting it.

The core elements of the infamous Lansley reforms remain in place – commercial contracts and the purchaser-provider split still the basis for delivering services, and the GP surgeries can be bought, sold or abolished. Lessons haven’t been learned from the pandemic, and there are proposals to keep the public health functions and communicable disease control  outside the NHS. 

We’ll now have a ‘ICS NHS body’ that would be the ‘cornerstone’ of the new bill. We’ll receive ‘single pot budget’ which will merge the budgets for general practice with acute and other services. It will abolish CCGs and take on some NHS England commissioning functions. The ICS will have the authority to generate their own priorities, for whom it will provide a service, and what service it will provide.

It won’t be under obligation to ensure that a whole range of services is available to their catchment population. Then there’s the potential that many ICSs will subcontract many of their activities to commercial organisations. If commissioning is outsourced, it becomes clear that GPs won’t be in control of the commissioning process. 

By the time of the next election – and, I predict, Boris Johnson still as Prime Minister – the general practice model of the last 72 years will have undergone revolutionary changes. We might begin to see GPs working as part of a broader ICSs, in larger teams and different settings – and for new employers.

These changes would be unrecognisable to a GP from 1948. The core thrust of the new reforms is to deprofessionalise and downskill the practice of medicine in this country, so as to make staff more interchangeable, easier to fire, more biddable, and, above all, cheaper.

Many GPs I talk to fear a total loss of autonomy as a result of ICSs. In fact, they quite rightly see ICSs as ‘the last nail in the coffin’ of general practice. 

Dr Kailash Chand OBE is a retired GP in Tameside

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