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BMA Chair of Council statement on Accountable Care Organisations (ACOs)

JMF 2018
BMA Chair of Council, Dr Chaand Nagpaul

The BMA has continued to raise our opposition to the proposed development of ACOs (accountable care organisations) in England. We originally raised concerns in our response to an NHS England consultation last November. After January’s council I wrote to the Jeremy Hunt to set out our concerns regarding, in particular, their establishment without due awareness and consultation of the far-reaching consequences with the public, doctors or even parliamentarians.

We have subsequently reiterated those concerns in meetings with NHS England, and in a set of briefings for members. In addition, on 27 February I gave evidence to the health select committee in parliament. In that session I made it emphatically clear that while the BMA supports collaborative care, we do not support the government’s ACO proposals, particularly in a climate of austerity and lack of NHS resources to meet patient needs.

ACOs would involve the creation of very large contracts covering significant geographical populations. Those contracts would be subject to competitive tendering as required in England as a result of the Health and Social Care Act. This means that whole health economies could, in theory, be taken over by commercial providers, and with ten-year contracts with exit clauses that could both fragment and disrupt services.

In addition, expecting the NHS to radically transform care for patients whilst also making unprecedented efficiency savings and coping with the worst service pressures in its history is totally unrealistic. Finally, the fully integrated ACO model involves radically altering the contractual status of GPs, who would become salaried or contracted to a single ACO organisation instead of independent contractors within a national NHS contract.

Later this month we understand that NHS England will launch a new consultation on accountable care organisations.

We had a productive meeting and have ongoing dialogue with JR4NHS, who will shortly be taking forward a judicial review to test the legality of the government’s proposals on ACOs. This judicial review has not come to court yet, but BMA Council has agreed that the Association will provide a witness statement if there is an opportunity to do this, so that we can support the process of holding the government to account.

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