-----Original Message-----
From: Mark O'Connor <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>; Ahmad Risk
<[log in to unmask]>; DFI <[log in to unmask]>
Date: 07 June 1998 21:39
Subject: RE: Meeting the GMSC
>Peter, could I have a history lesson please?
>Tell me why we should go back to FPC's. How did their structue differ from
>what we have now ie pre-PCG?
Hi Mark,
There are remarkable similarities between what is proposed in PCGs and what
used to exist in FPCs. FPCs were stuctured on the "partnership principle"
under which the professions agreed to form the NHS. The professions ( in the
case of FPCs GPs, dentists, opticians, and pharmacists ) had 50% board
input, the public had 50% (lay) input. There was a lay chairman. That
enforced minority (just) of professionals still exists in NHS regulation,
hence the need for regulation to be changed before PCGs could legally have a
majority of professionals, let alone GPs! It takes time to change
regulation, and the government does not seem inclined to hurry! Put that
together with the timescale for PCGs and...... you get the message!
FPCs were there to administer ( not manage) the contractor services. They
had administrators who understood the complexities of our terms of service.
HAs main interest has always been secondary care. Their managers were
senior, and when the new merged HAs developed, the old HA managers were
dominant. Only one merged HA to my knowledge had a former FPC administrator
appointed as it's chief executive. Hence the bias of current management
towards secondary care, neglect of primary care, and skewed purchasing
decisions based on poor understanding of the needs of primary care, and the
status of contractors in particular. Commissioning is only one small part of
what is intended for PCGs. Control, and clinical governance is in reality
much more critical to government intentions . The relationship which used to
exist between FPCs and LMCs would facilitate more acceptable developments in
clinical governance particularly, and I think would be more acceptable to
the profession. I think GPs will react badly when relatively small PCGs
start trying to impose clinical protocols/quality standards. There are going
to be some rather biased types sitting on PCG boards ( and I refer in
current context only to the professionals)- the pool of interested doctors
isn't going to be big enough to give much choice even if we get "democratic"
elections. Give such a body as the FPC ( reborn as a county-wide PCG), now
with a GP chairman,commissioning rights, and we could be going places.
Aberration, be it personalities of GP politicians, or fluctuations in demand
(budget) tend to level out as the likely aberration is diluted by scale.
Most fund holders got away with it, largely I think because of the liability
ceiling for expensive procedures. HAs have been able to control budgets
fairly accurately within 0.5% or so because their scale of operation makes
things statistically much more predictable. Many of them have now run into
deficit, however. My view is that PCGs will be too small to level out the
aberrations, either in personalities or budgets.
Regards,
Peter Fellows
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