Radical NHS reform unveiled
pharmafile | July 13, 2010 | News story | | GP, NHS, government
Radical reforms of the NHS have been unveiled which will give GPs control of the health system spending and see current management structures abolished.
Many commentators say the reforms are as great as any the health service has undergone since its creation in 1948, but opinions are divided on whether the plan to improve patient care and cutting costs can work.
England’s 152 Primary care trusts (PCTs) currently manage around 80% of the £105 billion NHS budget, but these will all be abolished by 2013 under the new plans, as will the 10 regional Strategic Health Authorities.
The plans are set out in the White Paper, Equity and Excellence: Liberating the NHS released yesterday by the coalition government.
Under the proposals, primary care doctors will be obliged to come together in consortia to take charge of the NHS budget for mental health, hospital and community services. These groups will start taking duties from 2012 and GPs will have full financial responsibility from April 2013.
This will be balanced with the creation of an independent NHS commissioning board that will allocate and account for NHS resources. The board will calculate practice-level budgets and allocate these directly to GP consortiums, as well as holding practices to account.
Giving greater power to GPs had been championed by Andrew Lansley before the election in June. Unveiling the new White Paper he said the reforms would “empower” doctors and tackle the frustrating bureaucracy that “plagued the health service”.
Lansley added: “We have got to design services better and save money. GPs are best placed to do this.”
A similar system, the general practitioner fund-holding scheme, was introduced as part of the Major government’s 1991 NHS reforms but was swiftly abolished after Labour came to power in 1997.
Even before this ‘fund-holding’ had faltered because too few doctors were involved – under Lansley’s new policy GPs will not be able to opt out of the system.
The NHS Alliance has welcomed the new proposals and its chairman Dr Michael Dixon said they offered a “unique opportunity for frontline GPs and the managers and other clinicians who work with them to make a real difference to the health of their patients, the services they receive and make the best out of limited resources.”
Dixon added: “The NHS Alliance will be leading from the front, supporting and enabling frontline GPs and practices to make it happen.”
Dr Amit Bhargava, clinical lead of the Clinical Commissioning Federation, said: “Clinicians – who spend 80% of the health resource, who have great influence on flows of patients, have organisation memory and have the intellectual capacity and capability – are in exactly the right place now to deliver the paradigm shift that will improve the well-being of the health service that is so critically needed.”
BMA chairman Dr Hamish Meldrum said doctors were ideally placed to help determine the health needs of their local population.
“Every time they see a patient they have to make decisions about their care, in partnership with them. Doctors, and their staff, already take the lead on designing services and innovating new treatments for patients and will be interested in discussing how these roles will be enhanced.”
But he added: “Any reorganisation of the NHS must take place in consultation with clinicians so that it does not cause any disruption to patient services or needlessly waste the valuable time of healthcare professionals.”
Mixed reactions
Other organisations went further in expressing their reservations about the plans, with think tank Civitas saying there was little evidence it would be better than the current system and even warned that restructuring could “set the NHS back by three years”.
Nigel Edwards, the acting chief executive of the NHS Confederation, said the proposed changes would create “a market dynamic”.
Speaking before the Paper’s publication he told the BBC Radio 4 Today programme: ” I think this is quite a major shift because the end product of these reforms will probably end up looking like the gas and telecom market rather than the NHS we have been used to in the sense big organisations making big contracts.”
Critics also point out that GPs have been taught to diagnose and to cure, not to allocate limited budgets and that this should be left to professional financial managers.
Some are also concerned that patient care may be adversely affected if primary care doctors are forced to spend too much time ‘balancing the books’ instead of spending it with their patients.
Ben Adams
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