Core aspects of of the Government’s health reforms were thrown into doubt this week after two GP commissioners resigned, saying that the demands of their new management roles were compromising their work as doctors.
The Clinical Commissioning Group (CCG) chairs for both Lewisham and Hull have left their posts, just four months after CCGs were set up around the country. Both departing chairs said the pressures of planning and buying in local health services, while also continuing their clinical role as family doctors, had become unmanageable.
Scrapping local Primary Care Trusts and replacing them with GP-led commissioning groups was one of the key reforms in the Government’s Health and Social Care Act 2012, which led to the biggest re-organisation of the health service in its 65-year history.
However, GPs say that the workload at their practices has “rocketed”, with both increased numbers of patients and additional targets enforced by the new GP contract, which was introduced in April 2013 at the same time as CCGs were established.
Dr Helen Tattersfield has stood down as chair of Lewisham CCG in south London. She told the general practice magazine Pulse that the demands of her commissioning role were “not compatible with good patient care” at her surgery.
In Hull, CCG chair Dr Tony Banerjee stood down last week saying that he had seen increasing pressure on both his role as commissioner and as a GP.
“It is with a really heavy heart I’m having to do it,” he told the Hull Daily Mail. “But it has been so hard juggling my two roles as GP and as CCG chairman…The practice is getting increasingly busy…I just don’t have time to do both and I am a GP first and foremost.”
GPs have warned the Government that their profession is “in crisis” with increasing pressures from an ageing population meaning that waits for a routine appointment have grown longer and longer. Pressure has been ratcheted up by changes to the GP contract, introduced in April, requiring practices to sign up to providing extra services – including screening for dementia – in order to receive their full funding package.
Family doctors say the changes have left them doing more work for the same amount of funding. Now signs are appearing that the CCG model, which is dependent on GPs having time to devote to commissioning services, may be under threat.
“Chair commitments are rather unpredictable and tend to migrate into days that should be clinical and expectation is to attend meetings at very short notice which is not compatible with good patient care as it can require cancelling surgeries,” said Dr Tattersfield.
In April, a third CCG chair, Dr Chandra Kanneganti, who led commissioning in Stoke, resigned the role saying he did not want to compromise patient care at his surgery.
Dr Chaand Nagpaul, chair of the British Medical Association’s GP committee, said that, while the CCG model was a good one, the resignations were indicators of the intense pressure GPs everywhere were under.
“This symbolises a far wider issue not just affecting CCG chairs but GPs in general, who are incurring an escalating workload meaning they have to focus on their practice and have less ability to engage and spend time on the commissioning agenda,” he told The Independent.
“Our view is that the government should reduce unnecessary workload in general practice. We believe the contract changes this year have added considerably to bureaucracy and added a new tier or targets within general practice. We want to work with government to reduce that burden so GPs have more time for patients and for their commissioning duties."
An NHS England spokesman said: “We do not want to increase the workload of GPs, but rather encourage GPs to work differently to meet patient needs... The recent contract changes change the way GPs are rewarded for the care they offer.
"Instead of being rewarded extra for routine office functions like record keeping, GPs are rewarded for steps that directly support and benefit patients, for example, better control of blood pressure and cholesterol, to prevent heart attacks and stroke and assessing patients at risk from dementia.”
A Department of Health spokesman said: "Our changes to the GP contract were put in place to help save lives and make sure care for people with long term conditions will continue to improve. Where possible, our changes were specifically designed to help practices manage workload at the same time as improving patient care. However, we know that GPs are under pressure, which is why we have asked Health Education England to aim to get 50 per cent of medical students to become GPs.”