NHS Confederation presses ministers to rethink health service reforms

NHS Confederation wants the plan for GP-led consortiums to take over from primary care trusts to be introduced more slowly

NHS chiefs are urging ministers to rethink their health service shakeup because the speed and scale of the radical restructuring could damage patient care and cause financial problems.

The government's failure to persuade health professionals that its proposals are needed is destabilising the NHS and alienating staff, the NHS Confederation warns. It represents 95% of the service's employers, such as the bosses of hospitals, primary care trusts and ambulance services.

In a new paper, the confederation says that the coalition should rethink its insistence that trusts be abolished in 2013 and replaced by consortiums of GPs to commission patients' care. Instead, the trusts should be allowed to continue and the new consortiums be given the freedom to develop slowly then gradually acquire control over treatment budgets, in what would be a major U-turn for the health secretary, Andrew Lansley.

The confederation's intervention comes amid intense government discussions involving David Cameron about how to improve the health and social care bill after the Liberal Democrat spring conference's call for major changes. Lansley has caused growing concern among coalition colleagues by failing to win over public opinion, or any major health or medical organisation, by insisting on a big bang approach to change in the NHS.

The confederation wants ministers to be much more flexible on the timetable for the introduction of the new system and allow the changes it wants ? such as handing GPs control of 80% of the NHS budget ? to happen much more slowly than planned in order to minimise the "significant risks" that may blight the transition period. "The debate on the reforms has become very polarised and entrenched," said Nigel Edwards, the confederation's acting chief executive. "This is destablising for an NHS that is already making structural changes to meet the government's agenda.

"We have often found a reality gap between ideas that are good in principle and the details of practical delivery, which have often looked opaque or too optimistic."

Lansley welcomed the confederation's paper, in a move that may reflect the fact that debate has shifted to the detail of how to improve his NHS masterplan, not whether his proposals need rethinking.

"The NHS Confederation is one of a number of organisations across the NHS that are now focusing on specific aspects of change, having supported the principles of our modernisation. We have common objectives and welcome input from the NHS Confederation on our comprehensive modernisation plan," he said.

Dr Hamish Meldrum, chairman of the British Medical Association, said the bill needed to undergo "significant changes to remedy its many problems" because, as drafted, it would harm the NHS by forcing different healthcare providers, both NHS and private, to compete with each other for patients and funding.

"There is now a strong coalition of those with major concerns," he said. "The government needs to pay much more than its current lip service to these concerns and take action to show that it really is listening to those who work within the health service."

John Healey, Labour's shadow health spokesman, criticised ministers for ignoring NHS managers' views on reform and being "determined to pursue its reckless ideologically driven reorganisation".

Two leading health policy experts echo the confederation's call for a more gradualist approach in a paper in the new British Medical Journal. Professor Chris Ham, chief executive of the King's Fund, and Professor Kieran Walshe of Manchester Business School also agree that the bill's aims are good, but they warn that its proposals may fail because ministers have alienated so many health professionals.

"The current disengagement evident across key groups like healthcare professionals and managers represents a serious challenge to the reforms. It would be a mistake to assume that these groups will simply come to accept the reforms in time, and there is a real risk of the reforms failing at considerable political cost to the government," they argue.

Meanwhile, fears are emerging that the switch to GP-led commissioning could create a two-tier primary care system in which some of the new consortiums are the medical equivalent of "sink estates" where poorer quality family doctors end up looking after poorer patients who have worse health. The Health Service Journal reports that in at least 17 existing primary care trusts, high-performing GP practices have joined with others from outside their areas to form a shadow consortium, or decided to go it alone, rather than linking up with nearby surgeries that provide lower quality care.

David Stout, director of the PCT Network, said: "I am sure there will be concern about some [consortiums] being the equivalent of 'sink estates', with all the most difficult practices, [and] most deprived populations, coming together."

Frank Atherton, of the Association of Directors of Public Health, said some consortiums could end up "cherry-picking healthier populations" and that "the more deprived and less affluent people [may] get left behind with the poor performing GPs".

Denis Campbell

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