- GPs felt they would be most clinically accountable to their patients and consortium, and most financially accountable to their consortium. They felt less accountable to local authorities and hospitals. - GPs believed GP-led commissioning would focus heavily on cost reduction and potentially lead to restrictions on patient choice and access to services. - Rural GPs were more opposed than urban GPs to patients choosing practices outside their normal area, though most GPs estimated few patients would actually switch practices.

1. GP Omnibus Feb 2011 GP-led Commissioning Prepared for the Nuffield Trust

2. For clinical matters, GPs feel the highest level of accountability will be to their patients, their Consortium and their colleagues (and the lowest level of accountability will be to local government/local authority and NHS Hospitals) Q1 . Focusing on clinical matters, to what extent do you feel that you will be accountable to the following (once GP-led Commissioning has been fully introduced): Base: 817

3. For financial matters, GPs feel the highest level of accountability will be to their Consortium, then their colleagues (and the lowest level of accountability will be to NHS Hospitals and their local government/local authority) Q2 . Focusing on financial matters, to what extent do you feel that you will be accountable to the following (once GP-led Commissioning has been fully introduced): Base: 817

4. GPs feel that they will be more clinically accountable to their patients, the Care Quality Commission, NHS Hospitals and colleagues - and that they will be more financially accountable to most of the official bodies (DH, NHS etc) Q1/Q2 . Focusing on [Q1: clinical / Q2: financial] matters, to what extent do you feel that you will be accountable to the following (once GP-led Commissioning has been fully introduced): Base: 817 Balance between the 2 increasing towards clinical matters Balance between the 2 increasing towards financial matters s

5. It is predicted that consortium priorities will mostly mirror the GPs’ preferred priorities – but with less emphasis on the quality of outcome, and much more emphasis on the location of the service being within the consortium boundary Q3 . Please rank the following in terms of the priority that you believe your consortium a) should follow when commissioning elective services, and b) will probably follow when commissioning elective services: Base: 817 [The higher the average score, the higher the relative priority]

6. GPs believe that GP-led commissioning will focus on cost (with nearly two thirds indicating that the focus will be “very much” on cost) Q4. To what extent do you think that GP-led commissioning will focus on cost? Base: 817

7. Overall, GPs expect that an active focus on cost is likely to lead to different types of restrictions (and possibly preventions) – along with a reduction of patient choice Q5 . If it transpires that GP-led commissioning does actively focus on cost, to what extent do you think that a focus on cost will lead to: Base: 817

8. Two thirds of GPs (67%) do not believe that patients should be able to choose a GP practice away from their normal area... Q6. To what extent do you agree with the following statement? “ Patients should be able to choose a GP practice away from their normal area” Base: 817

9. ...even though more than three quarters of GPs think that 5% or fewer of their patients will actually choose to switch to a GP practice elsewhere Q7. What proportion of the patients registered at your practice do you think will actually choose to switch to a GP practice elsewhere? Base: 817

10. A higher proportion of GPs in a rural area are opposed to the idea that patients should be able to choose a GP practice away from their normal area, and a higher proportion of GPs in an urban area are in favour of it Q6. To what extent do you agree with the following statement? “ Patients should be able to choose a GP practice away from their normal area” Base: 817 Bases: 817 65 239 178 329 6

11. In contrast, rural area GPs predict the lowest uptake and urban area GPs foresee the highest level of switching elsewhere (on average) Q7. What proportion of the patients registered at your practice do you think will actually choose to switch to a GP practice elsewhere? Base: 817 Bases: 817 65 239 178 329 6

12. Nearly 2-in-5 of GPs indicated that they would feel less comfortable (than under the old system) if they were discussing patient care matters with secondary care doctors that they were unlikely to commission Q8. With regards to discussing patient care matters with secondary care doctors under the new GP-led commissioning system, please rate how comfortable you think that you will be (as compared with how you’ve felt under the old system) in the three different situations outlined below. Base: 817 [*than under the old system]

13. Nearly two thirds of GPs predicted that the proposed reforms will lead to the increased usage of private providers (rather than NHS providers) Q9. In terms of the future usage of NHS or private providers for hospital services, which of the following do you think will be the most likely outcome of the proposed reforms? Base: 817

14. Only a very small minority of GPs (4%) think that the reforms will have no impact on the financial viability of their local hospital – whereas 50% overall believe that the reforms will have a major impact on viability Q10. What, if any, impact do you think the reforms will have on the financial viability of your local hospital? Base: 817