The GP surveys conducted for the Department of Health also show that patients have high levels of satisfaction with their GP. In 2010, nine out of ten patients were satisfied with the care they received at their surgery and over half of patients were ‘very satisfied’ (54 per cent). Only four per cent of patients were dissatisfied with the care they received. This suggests that the current doctor-patient relationship is highly valued and that the public place a significant degree of trust in doctors as professionals. How might the changes proposed by the Health Bill threaten this?
What does the Health Bill propose?
The Health Bill proposes that all GPs will need to be a member of a GP commissioning consortium in order to have a registered list of patients. The consortia would hold £60 billion of taxpayer's money and commission the majority of hospital and community health services for patients. It is proposed that an element of GP pay would be linked to their consortium's commissioning performance.
What might be the dangers in these reforms?
If patients believe that GP decision-making is being influenced by personal financial gain this could erode their trust in GPs as professionals. The British Medical Association has raised concerns about this issue.
There are two key ways in which financial considerations and patients' clinical needs potentially come into opposition and could reduce patient trust.
The first is at the point of referral. In the future, patients may believe that a GP has decided not to refer them for specialist treatment not on clinical grounds but solely because they want to keep the consortium within budget (as the GP would gain financially from this). Evidence suggests that many patients seek referrals that they don't necessarily need clinically, putting GPs in a particularly difficult position.
Further threats come from the proposed changes to the role of the National Institute for Health and Clinical Excellence (NICE). While NICE will continue to undertake economic assessments of new drugs, it will no longer be compulsory for GPs or providers to abide by NICE guidance. It creates the possibility in a patient’s mind that GPs might make and support prescribing decisions on economic rather than clinical grounds, again undermining trust. Both sets of circumstances underline how important it will be for GP consortia to have strong governance and transparent decision-making processes.
What might be the benefits in these reforms?
On the other side of this argument is the experience of GPs who have already been actively engaged in commissioning, many of whom have worked very closely with patients in developing services and taking commissioning decisions.
For example, the GP commissioning group Principa follow the principle that not a single decision should be made without patients being involved from the outset. This principle has brought patients closer to GPs and strengthened rather than damaged the doctor-patient relationship. It is likely that GP consortia will be required to provide evidence of how they plan to engage patients in consortia work.
Is it a myth or a fact?
We're still undecided. While the proposals laid out in the Health Bill do have the potential to undermine the high level of trust that patients currently have in doctors, they could also drive a much closer and more equal relationship between GPs and their patients. This is one to watch over the next few months.