The government is to push ahead with big structural changes to the NHS in England.
PCTs are to be abolished and, from 2013, family doctors will plan and commission healthcare and manage the budgets to pay for it.
The government has carried out a public consultation on reform plans and, despite criticism from some doctors, nurses and patients groups, health secretary Andrew Lansley said he will press ahead.
The following are the key responses from the sector:
The King’s Fund
Chris Ham, chief executive of the King’s Fund, said: “The government has announced some positive steps today to help manage some of the risks involved in a radical reform of the health system in England.
“We’re pleased that the government has recognised the inherent risks present in the NHS white Paper proposals and taken steps to mitigate against some of these. In particular testing key proposals before fully rolling them out, as we and others recommended, will provide a much more robust base on which to build the new system. It is also very positive that the government has recognised the importance of ensuring that the skills and expertise of staff currently in PCTs should not be lost in the transition to the new structure.
“We also welcome the stronger role signalled for local authorities including wider scrutiny powers and the commitment around pathfinder GP consortia, the introduction of early implementation of health and well-being boards and the establishment of a Provider Development Authority to support the move to an all-foundation trust hospital sector.
“While the government has recognised the need to ensure that better integration lies at the heart of improved care for many patients - what is not yet clear is whether the incentives in the new system and regulatory framework will allow integrated services to grow, rather than stand in the way of their evolution.
“We would disagree with the assertion that structural changes will help to meet the productivity challenge and the ambitions of the government’s QIPP agenda. While proposals are being phased in more carefully over four years, we share the concerns set out by the Health Select Committee yesterday, that they will still act as a distraction from delivering the enormous productivity improvements required across the system.”
Royal College of General Practitioners
Dr Clare Gerada, chair of the Royal College of General Practitioners, said: “We are pleased the government has responded to some of our members concerns such as the need to engage with other clinicians and patient groups.
“We welcome that GPs are still central to the planning of health services for their patients and instrumental in leading the design of local services to deliver the best outcomes for patients.
“However, we still have a number of questions. These include the pace of change and how this sits alongside having to make unprecedented savings; how to balance patient choice with health inequalities (those with the greatest health needs are often those with the least ability to exercise choice); and how the policy of ‘any willing provider’ may impede the development of effective coordinated services as well as drive up the cost.
“Our starting point is what delivers the best outcomes for our patients. We firmly believe putting GPs at the centre of commissioning is the right way forward and we will continue to engage with the Department of Health to shape the policy so it is safe for patients, safe for GPs and safe for the NHS.”
Royal College of Physicians
Dr Patrick Cadigan, registrar of the Royal College of Physicians said: “It is encouraging that the government was prepared to take on board some of the concerns we raised. The RCP believes strongly that good decision-making hinges on professional groups, communities and patients working together. This was a point made repeatedly by others during the consultation process and we are pleased that it has been partially recognised, in that that the forthcoming Bill will provide for consortia to make arrangements to ensure that they have appropriate advice from professionals with expertise in health. However, we will continue to press ministers for a framework that formally mandates specialist involvement in commissioning.
“More broadly, the government is right to adopt a more phased approach to its reforms. Whichever way you look at it these are an ambitious set of proposals that happen to coincide with the biggest efficiency drive in the service’s history. Robust piloting of the plans, doing more to get staff on board, and a degree of flexibility around their implementation will all be key to ensuring that the plans deliver for patients in the ways intended. There should be no place for dogmatism when we are talking about so many people’s lives, and this amount of public money.”
BMA
Dr Hamish Meldrum, chairman of council at the BMA, said: “There is little evidence in this response that the government is genuinely prepared to engage with constructive criticism of its plans for the NHS. Most of the major concerns that doctors and many others have raised about the white paper seem, for the most part, to have been disregarded. The response completely fails to acknowledge that proposals to increase competition in the NHS will make it harder for staff to work more co-operatively. While we still believe that clinician-led commissioning can improve patient care, this document does not provide assurance that it will be implemented effectively.
“The government also seems to have ignored the warnings of the BMA and many others about the pace and scale of these reforms. Change of this magnitude was always going to be a challenge and the worsening financial pressures on the NHS, coupled with the ambitious timescale and lack of detail, make the present strategy very risky. Given the latest inflation figures, we do not accept the government’s claim that it is increasing real terms funding for the NHS. The stated 3% ‘increase’ in funding for PCTs includes £1 billion already announced to cover additional social care responsibilities and masks the fact that hospitals will have to do a lot more work to achieve the same income. Patients across the country are already discovering that local services are being rationed to achieve efficiency savings, and there are likely to be further NHS cuts on a scale we have not seen for many years.
“The BMA will consider the government’s response in detail, but our initial reaction is that they seem committed to charging forward with these changes despite the warnings and despite the risks.”
Royal College of Paediatrics and Child Health
Professor Terence Stephenson, president of the RCPCH, said: “The Royal College of Paediatrics and Child Health is very positive about the commitment to integrated care for mothers and their babies and that more specialist newborn services continue to be provided by geographical networks rather than piecemeal by any willing provider.
“We welcome very strongly the statement that the National Commissioning Board will commission specialist neonatal services and are very positive about the emphasis on a ‘joined up approach to local services for women and newborn babies’.
“We would stress that the outcome we are looking for is that there are joined up health services between mothers and their babies, joined up health services between specialist newborn intensive care and more routine newborn care delivered locally. We would also want to see the Healthy Child Programme being delivered successfully, largely by GPs beyond the first week of life and outside hospital.”
“We also strongly welcome the emphasis on joined up care for children with specialist complex illnesses and agree that in many cases the arguments for the commissioning of specialised services on a national or sub-national level are irrefutable and of enormous benefit in terms of quality of service for children and economies of scale for the NHS. Examples would be children with insulin-dependent diabetes, cerebral palsy or epilepsy where there is a need for expert teams to manage difficult and long-term problems.
“The secretary of state’s response quoted the Royal College of Paediatrics and Child Health as stating ‘the development of sub-national commissioning will enable either sub-groups of the National Commissioning Board or clusters of GP consortia to collectively consider commissioning requirements’.”
Royal College of Obstetricians and Gynaecologists
Dr Tony Falconer, president of the RCOG, said: “Maternity services require a range of specialists to work together including obstetricians, midwives, anaesthetists and neonatologists and central commissioning can better ensure safe and high quality care to women and their babies.
“This is a missed opportunity to deliver a seamless, uniform maternity service. However, we are pleased to see that the NHS Commissioning Board will focus on promoting quality improvement and extending choice for pregnant women.
“We welcome the statement encouraging consortia to pull together resources and develop larger commissioning units. We trust this will make the development and functionality of perinatal networks more likely resulting in improved service to mothers and babies.
“We believe that the concept of maternity networks is key to providing a multi-disciplinary and efficient service for patients and we look forward to working with other stakeholders in defining the appropriate structures. These networks would work with local public health and social services when necessary.
“We are determined to work with our colleagues at the RCM, RCPCH and RCGP’s to make this strategy work and ensure that local commissioning is based on the highest clinical standards.”
Read an at-a-glance guide to GP commissioning.
Tags: Health policy
