The Coalition government’s plans to hand over financial responsibility for commissioning health services in England has met a concerned response from the people the new regime is supposed to “liberate” – the general practitioners.
As Workers went to press, the Royal College of General Practitioners (RCGP) had yet to give a final response to the White Paper Equity and Excellence: Liberating the NHS, but a “framework” document issued on 13 September gives a flavour of the concerns running through the profession.
Doctors’ newspaper Pulse revealed on 16 September that it had received a phone call from the Department of Health expressing “the full force of the DH’s displeasure as it attempted to stamp on signs of rebellion from GPs”. The newspaper also called the RCGP’s response “surprisingly strongly worded”.
There were “a significant number of comments on the risks of these reforms to the NHS in England”, the RCGP’s framework response states. Primarily, “Rather than efficiency savings, both financial and human resources would be diverted away from clinical care and quality improvement into issues around commissioning and resource management.” On top of that, doctors worry that the extent and speed of the reforms could damage the personal and economic relationships between health service organisations.
Among other issues, GPs are worried that different policies by local fundholding consortia will increase rather than reduce health inequalities. And they are acutely aware of the consequences of holding the budgets: “GPs will be seen as the purse-holders: this could reduce public trust and decrease their ability to advocate for patients, and they will be blamed for failures and cuts in services.”
The response also says what many people have been saying about the proposals: that for most GPs commissioning requires time, skills and resources that they just don’t have.
Privatisation is another worry. “The reforms open a door to increased involvement of the for-profit private sector in the NHS, and tax payers’ money will be diverted into private companies and their shareholders,” say the GPs. “This could be seen as the break up of the NHS with some private companies ready to take over the provision of services.”