The Government’s White Paper for the NHS has been dismissed as a ‘political experiment’ that could destabilise the health service.
Critics claim the proposals, which will see the abolition of PCTs and SHAs and the emergence of commissioning led by GP consortia, represent a significant U-turn from a coalition Government who only weeks ago promised there would be no top-down reorganisations of the NHS.
But NHS Chief Executive, Sir David Nicholson, said the document – Liberating the NHS – set out a ‘compelling vision’ for an NHS configured to deliver increasing quality of services.
“The ambition is high and the proposed timetable is rapid,” he said. “The vision needs to be realised through a period in which the NHS needs to achieve £15-20 billion of efficiency savings to reinvest in improving quality and outcomes. This represents a significant delivery challenge.”
Shadow Health Secretary Andy Burnham labelled the changes a political experiment. “It is a huge gamble with an NHS that is working well for patients,” he said.
Under the new proposals, GPs will be handed around £80 billion of the NHS budget to commission patient care, with vast swathes of NHS management positions being cut away. Tens of thousands of jobs in PCTs and SHAs will be shed in the next four years. SHAs will be “abolished as statutory bodies during 2012/13” and PCTs “from April 2013”.
The reforms will once again redraw the pharmaceutical industry’s customer-base. It will undoubtedly impact the industry’s sales methodology – and may well facilitate a move back towards primary care field forces, albeit on a much smaller scale.
Andy Lee, Commissioning and NHS Partnerships Director at WG Consulting said: “The White Paper promises significant reform and a renewed focus on quality and patient outcomes. However, it appears to offer equal measures of increased opportunity and exposure to risk. The devil will be in the details and the negotiations to follow.”
The King’s Fund described the programme as being unlike “anything we have seen since the inception of the NHS in 1948”. It said the plans were “not without risk” and that some GPs would not have the skills to manage the budget. Sir David Nicholson agreed, saying that the scale of change being proposed was “unprecedented and affects all parts of the service”.
“The lesson of past reorganisations was that there is a ‘significant risk’ during this transition, of a loss of focus on quality, financial and performance disciplines as organisations and individuals go through change,” he said.
Nicholson had appeared to question the Government’s plans, in particular the proposed speed of change. Speaking at last month’s NHS Confederation conference, he said he doubted the reforms would be anywhere near completion for full implementation by the date set by the Health Secretary, and that the transfer of NHS commissioning to GPs by 2012 was ambitious. “It’s dangerous to put a date of that nature on it,” he said. Nicholson outlined his views on the size of the challenge ahead, saying that on a scale of one to ten, even the best GP practice based commissioners were “only about a three in terms of the quality of their commissioning”.
A report by independent Think Tank, Civitas, claims that evidence suggesting GPs will be more effective than health trusts at commissioning is ‘weak.’ The report says: “There is no evidence to draw on to support GPs across the country taking on commissioning as consortia.”
But Dr Amit Bhargava, from 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.”
The NHS Alliance welcomed the proposals, saying it supports a phased approach to clinical commissioning, with a clear and agreed road map. Dr Michael Dixon, Chairman of the NHS Alliance, said: “This is 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.”
Dr Tim Riley, Chief Executive, NHS Tameside and Glossop, said: “The NHS faces difficult funding decisions but we can, and should, use local clinical know-how to get the best for less. The mechanics of commissioning need to be unleashed from bureaucracy. A remaining challenge will be for the new Regional Divisions of the Independent Commissioning Board to embrace the new agenda and not reinvent themselves as SHAs or ultra large PCTs. The NHS top down approach can then be replaced with GPs leading from the grass roots up.”
David Cameron and Andrew Lansley speak with a group of nurses during a visit to The Royal Marsden Hospital in London, on the same day that the White Paper was launched.
