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Cllr Jonathan McShane, Cabinet Member Health, Social Care & Culture, writes about the recent dispute in Hackney over out of hours GP cover...
A dispute in Hackney over who provide out of hours GP cover is a worrying taste of things to come for the NHS and makes a mockery of putting GPs in control.
Local GPs in Hackney, worried by the performance of private firm Harmoni delivering out of hours care, have worked for over two years developing their own social enterprise solution. Up and down the country we hear worrying stories about private out of hours services, particularly around continuity of care. When asked, most people would choose to go back to the system where they are seen by local GPs when they need care outside normal hours. At a time when the focus is rightly on greater integration in health and social care it surely makes sense to build on the relationships local GPs have with their health and social care partners.
Roll back to February 2012 and embattled then Health Secretary wrote to GPs leading emergent CCGs to dispel some 'myths' that had arisen around his Health and Social Care Bill. He wrote:
"I know many of you have read that you will be forced to fragment services or put services out to tender. It is a fundamental principle of the Bill that you as GPs, not the Secretary of State and not regulators should decide when and how competition should be used to serve your patients' interests."
The North East London board of the NHS have now decided that the Hackney out of hours social enterprise could not take back services in their area. In the view of GPs, as they were opting back in to providing their own cover, a procurement exercise was not necessary. The contract with Harmoni, part of Care UK, will now be extended for up to nine months and the CCG will have to run a full procurement exercise over the next few months. Harmoni and other private providers will now compete alongside the local social enterprise for a multi million pound contract. The NHS board in North East London has taken a decision that goes against what GPs feel is best for patients and that has gone down badly with worried local residents. The fear of being sued by private healthcare companies has overridden the patient interest.
The same fear will haunt the CCG in Hackney as they undertake their procurement process and this is going to happen with service after service across the country. Instead of GP commissioners being able to decide where independent providers might be able to offer a service or approach that can complement local provision, private providers can use the threat of legal challenge to start picking off services and fragmenting the local health and social care system. Every attempt to integrate by building on established local relationships will be undermined by the fear of legal challenge.
If GPs are not in control of something as fundamental as who provides their own out of hours care how can we believe CCGs will have the ability to use their knowledge of the local area and their understanding of local providers to commission the best services for their residents?