Leading doctors voice concerns that reforms will suffocate GPs and jeopardise promised freedom to commission care
Two prominent backers of the coalition's NHS shake-up have joined the growing chorus of critics by claiming that GPs will be "suffocated rather than liberated" by the planned changes.
Dr Charles Alessi and Dr Michael Dixon have helped Andrew Lansley claim credibility for his plans among doctors over the past 18 months by strongly supporting his radical restructuring. They are leading lights in the NHS Alliance and the National Association of Primary Care, two key pro-reform organisations.
But they now fear that the new consortiums of local doctors, which will start commissioning healthcare for patients in England from next year, will not have the freedom that the health secretary has repeatedly pledged. Lansley has attempted to persuade sceptics that his reorganisation will put family doctors in charge of healthcare.
NHS primary care trusts (PCTs) and strategic health authorities (SHAs) are due to be abolished next year.
But the doctors are worried that the GP-led clinical commissioning groups (CCGs), which will replace PCTs, will find themselves unexpectedly under the control of another organisation, the NHA National Commissioning Board (NCB).
In July the NHS chief executive, Sir David Nicholson, said "CCGs will be the engine of the new system" and that the reformed NHS "gives pride of place to clinical leaders". But the reality is that primary care doctors and clinical commissioners will not have the promised ability to make key decisions because the current bureaucracy is simply being replaced by another that is growing up around the NCB, the pair claim.
The Department of Health's latest document about the design of the new board involves "layers of bureaucracy and management, with complex guidelines. The old 'footprint' [of the PCTs and SHAs], ie 50 local offices, remains there, plus four sector outposts, all using a single operating model," the two organisations said in a joint statement .
The fact that many of the staff of the new NCB will simply be staff who have joined from PCTs and SHAs "adds to clinical commissioners' concerns and perceptions that they will be suffocated, instead of liberated, which in our view is fundamental to the success of clinically-led commissioning", they added.
"What we are hearing and seeing are the same old messages and the same old structures, albeit with new nomenclatures", said Alessi, a key figure in a CCG in south-west London.
"If we put the same ingredients into the mix, the likelihood is that we shall deliver the same inefficient environment and outcomes. This is insupportable in an economy of tight financial restraint."
Most CCGs now see the new board as the greatest threat to their effective functioning, added Dixon, a GP in Devon and chair of the NHS Alliance.
The pair's comments are another blow to the health secretary as his health and social care bill prepares to undergo its report stage in the House of Lords, when peers will seek to force the government to accept further amendments to its plans. Labour seized on the men's remarks as further evidence of the growing concerns the bill is causing.
"Things are going from bad to worse for Andrew Lansley. In the last fortnight there has been a deepening crisis of professional confidence in the government's health bill, but until now the health secretary could rely on the support of the NHS Alliance and the National Association of Primary Care," said Andy Burnham, the shadow health secretary.
"Yet the bill's biggest cheerleaders are now lambasting the increasing layers of bureaucracy. Even the health bill's greatest supporters are now concerned that Lansley's plans are so complex and full of worrying uncertainties that they risk thwarting the principle of true clinician-led commissioning."
The British Medical Association also fears CCGs' freedom will be curtailed. "There are significant concerns that CCGs will not have genuine freedoms and sufficient independence to make locally sensitive, locally accountable, patient-focussed decisions," it said.
In a briefing to peers ahead of the report stage it says that, despite ministers agreeing to amend several aspects of the bill, the legislation should still be dropped because it involves too much use of "market forces", and could also affect doctors' relationship with their patients through financial incentives for CCGs.
The Department of Health said: "By handing power and responsibility for choosing and purchasing services to doctors and nurses on the ground, we are shifting the decision making closer to patients and building on the trusted role that GPs and other front line professionals already play throughout the NHS.
"The NHS commissioning Board will provide national standards, but doctors and nurses will have the freedom to make decisions about their patients and their organisations." The Guardian
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