The prospect of new GP-led commissioning consortia in England replicating soon-to-be-abolished primary care trusts (PCTs) would be a "scandal", the president of the National Association of Primary Care (NAPC) has warned.
Speaking at the Management in Practice Event in Birmingham, Dr James Kingsland (pictured), a GP and National Clinical Commissioning Lead for the Department of Health, said there ought to be a "public outcry" if clinical commissioning groups (CCGs) were simply to recreate the PCT structure.
A longstanding champion of clinical commissioning, Dr Kingsland said that CCGs were better off "starting small" so that local practice teams could focus on the needs of their local populations and make the essential efficiency gains required by the health service over the next four years.
"Let's be clear: CCGs are the constituent practices," he said. "If we recreate the bureaucracy that this legislation is trying to get rid of, if we recreate 150 CCGs with about 300,000 populations, there should be a public outcry because it would be a scandal."
He said this was because central to the government's reforms was that local clinicians would be accountable to get better outcomes for their patients.
Dr Kingsland's speech was dominated by talk of the need for the health service to make 4% efficiency savings by 2015. He insisted this would not be achieved by a centralised system, but by "every practice" in "every community" effectively reducing wasteful spending.
He told hundreds of practice managers and GP delegates that the "bottom-up" reforms had to be a fundamental change to previous delivery, and that practices would have to become "more productive with what is protected".
He said: "The idea that we'll solve the [efficiency] problem by producing CCGs that are bigger organisations than PCTs and by putting a few clinicians in the place of expert managers is one of the biggest myths flying around the system."
Dr Kingsland said practice managers were "so important" to general practice in this financial climate, as practices' "fixed budgets will mean income is entirely dependent on how you manage expenses".
Dr Kingsland also insisted that the efficiency savings challenge was "not unprecedented" in general practice. He claimed that a King's Fund report showed that in the fundholding era, practices that had managed their budgets had achieved 4% efficiency gains over seven years.
"That's what we really need to get back to [to deliver] what is expected by these reforms," he said.
But he warned this would not be an easy task. "Can we change behaviours in every consultation, every day, in every general practice in every community clinic in England? Because if we can't, we will fail," he said.
He also dismissed suggestions that the concept of local commissioning groups could be a short-term arrangement to be revised by a successive government, saying there was "no alternative" to the central thrust of the reforms.
Do you believe CCGs will resemble PCTs, or do you think the new system is set to transform the health service? Your comments (terms and conditions apply):
"I hope not! It depends on the dynamism and enthusiasm of the commissioning leads and how they are influenced by the PCT staff still in positions of control as the CCGs are established" – Name and address withheld
"One of the main reasons Andrew Lansley is in so much bother is that he listened to this guy" – B Minelli, Luton