The government’s health reforms risk failing vulnerable groups unless GPs are put under greater pressure to work with local authorities to improve care in local areas.
That was the verdict of a two-year inquiry into general practice commissioned by think tank the King’s Fund that reported this week.
With the Health and Social Care Bill set to hand consortia of GPs £80bn in annual funding to commission healthcare from 2013, the report raised significant questions about the legislation and GPs’ readiness to take on a wider role, particularly in relation to vulnerable groups.
Provisions in the bill to forge closer joint working between GP consortia and local authorities were “weak”, it said. Consortia will have to be members of health and well-being boards – council-led partnerships that will set local care strategies – and submit their commissioning plans to them.
However, the report said this was insufficient. It found many GPs were “isolated” from other health and social care professionals and said the fact that GP consortia would not share boundaries with local authorities in many cases would pose a further barrier to joint working.
This would be to the detriment of services for groups such as people with mental health problems, learning disabilities, dual diagnosis or multiple long-term conditions, who require jointly planned health and social care services.
It also said GPs had a key role to play in tackling health inequalities and providing for groups that did not traditionally receive their services, such as homeless people, refugees and asylum seekers and problem drug and alcohol users.
However, with councils set to take responsibility for public health under the NHS reforms, it said there was a “significant risk” that GPs would shun this area, and that “the opportunity for effective joint working to address health inequalities will be lost”.
The report recommended that the performance management regime for GPs should reflect public health and social care outcomes and align with targets for councils. It also called for GPs to take on a new role of care co-ordinator, with responsibility for signposting patients to wider forms of support, including housing, social care and benefits.
“I hope general practice will rise to the challenges set out in this report and seize the opportunity provided by the development of GP commissioning to deliver the improvements in quality needed,” said Sir Ian Kennedy, the chair of the independent panel that produced the report.
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