Lansley’s ‘Quality Premium’ raises further concern over the health bill

Dr. Charles West, who has been a GP and an NHS manager, writes about the latest potential conflicts of interest over the health bill - namely the 'Quality Premium'.

Dr. Charles West has been a GP and an NHS manager, and in 2010 he was the Liberal Democrat Parliamentary Candidate for Shrewsbury and Atcham; he was asked to contribute this article but has no links to this blog

The GMC has a guidance booklet outlining the duties of a doctor. The first requirement is to “make the care of your patient your first concern”. Generally I believe that doctors live up to that duty. Most patients trust their doctor and maybe that is why doctors repeatedly come out as one of the most trusted professions, whereas politicians vie with journalists and bankers to be the least trusted.

If you see your doctor now, and she says that you do not need an X-ray, there is likely to be only one reason that she is saying that. She believes that you do not need an X-ray; indeed having an X-ray may do you more harm than good.

Would you feel differently if your doctor held the budget for buying X-rays, and if you knew that the budget was under some pressure? That is one reason that as GPs most of us had an ethical problem with the Fundholding scheme introduced by the Thatcher government in the 1990s.

We know that NHS budgets are going to be under great pressure over the next five years. What a coup for Andrew Lansley if he were able to make the GPs responsible for all the rationing decisions?

Making the GPs responsible for NHS budgets raises a number of possible conflicts of interest. The one that is likely to affect more GPs than any other is the Quality Premium. Laurence Buckman of the BMA has criticised it as unethical. Health minister Paul Burstow’s response in March was to say the intention of the Quality Premium was that:

“…commissioning consortia will be rewarded for is improving the survival rates, improving the quality of care.”

Unfortunately there is no indication of how survival rates or quality will be measured. So let us look at the guidance from the Department of Health. The policy of GP commissioning has two objectives. One of which is “to align clinical and financial responsibility in decision making”.

And on the Quality Premium:

“…a proportion of GP practice income – in the form of a ‘quality premium’ – should be linked to… effectiveness with which they manage financial resources… [it will] create a strong incentive for GPs to work to ensure effective management of referrals and prescribing.”

Meanwhile, let us look at what is happening on the ground. I know of a GP Commissioning Consortium in shadow form that proposes to deduct 15 per cent of the salary paid to GPs and to let them earn it back if they comply with the consortium’s referral guidelines and objectives. If you absolutely trust the Commissioning Consortium this may all be fine.

But bear in mind the Commissioning Consortia will have fixed spending limits, and many will farm commissioning out to private companies, and I am afraid the Quality Premium could damage patient care and destroy the trust between patient and doctor.

The Quality Premium is just one of the many things that should be removed from the Health Bill.

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