Charities say GPs lack expertise to commission all services

GPs lack the expertise to commission care services for vulnerable adults and their proposed new powers could lead to postcode lotteries, campaigners have warned.

The government yesterday published its health White Paper, which included plans to abolish primary care trusts and hand commissioning responsibility for most health and services to consortia of GPs.

But several charities have warned that GPs lack the knowledge required to carry out this role in relation to vulnerable groups.

Paul Farmer, Mind chief executive, said: “GPs currently lack the specialist mental health knowledge and training to understand the complexities of mental health commissioning.”

He spoke after research published on Monday by mental health charity Rethink found that only 31% of GPs felt equipped to take on the role of commissioning mental health services.

Farmer warned the result could be a “micro-postcode lottery”. He argued that access to talking therapies for mental health conditions remained patchy while the number of prescriptions for anti-depressants had risen.

Val Buxton, director of policy at Parkinson’s UK, said she didn’t want to see inequalities in care provision. She said: “This will only be achieved if GPs are truly accountable to the local community for commissioning services that meet evidence based standards such as Nice [National Institute for Health and Clinical Excellence] guidelines and national service frameworks.”

Ruth Sutherland, acting chief executive of the Alzheimer’s Society, echoed Buxton’s comments and added that GPs would need to have good links with both health and social care services to ensure patients did not fall between the gaps.

GPs would also need to improve their understanding of deafness, old age and end-of-life care to commission effectively, charities said.

Jackie Ballard, chief executive of the Royal National Institute for Deaf People, said: “Our evidence shows that GPs often don’t refer patients, especially older people, with hearing loss to audiology services. This means that patients don’t get fitted with a hearing aid, and risk becoming socially isolated and withdrawing from employment, which could mean that they develop mental health problems.”

Michelle Mitchell, director at Age UK, said GPs often overlooked needs of older patients and this risked age discrimination in the provision of services.

Jonathan Ellis, director of policy at Help the Hospices, said: “Ensuring that people who are dying receive the best care can be the most difficult thing to do. But worryingly, research has shown that GPs are the least confident among doctors in identifying the point at which their patients need end-of-life care.” He added that GPs would need support to develop expertise in palliative care.

Responding to the concerns, care services minister Paul Burstow said GPs could buy in expertise from specialist organisations to help them commission services. He added: “That means that an organisation that has an expertise in mental health services could well become the commissioning expertise that a GP consortia use. There are examples already around the country where PCTs have been using other bodies to assist them to be smarter about populations they know less about because those organisations are much closer to them. That’s one of the opportunities that this White Paper will offer to GPs.”

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