Health secretary Jeremy Hunt has a ‘window of opportunity’ to address grave concerns about emerging problems with NHS reform.
BMA council chair Mark Porter told a fringe event at the Conservative Party conference in Birmingham that the reforms in England had got off to a ‘wheezy’ start and the BMA was getting reports of problems on the ground that were leaving some doctors disillusioned.
‘There is a window of opportunity for the new secretary of state to listen to the grave concerns about whether the reforms can be implemented sensibly and, if not, for him to consider what urgent action can be taken to limit the potential for long-term damage,’ he said.
Dr Porter told the event that while the idea of clinically led commissioning was ‘always laudable’, as CCGs (clinical commissioning groups) began the authorisation process to become statutory bodies, concerns are emerging about the level of genuine engagement with local clinicians.
‘We are hearing worrying reports that some CCGs are developing inappropriate constitutions and are pressurising GPs to sign up in a hurry. And in the process, GPs are becoming increasingly disillusioned with the development of their CCGs,’ he said.
Lack of ownership
Dr Porter added that there was a risk that the new structures would simply replicate the old with no sense of ownership among the wider profession for the decisions being taken on their behalf.
He said that the health service could be ‘on a long and unknown path that could see these groups in five to 10 years continue to operate without the necessary involvement and engagement from GPs up and down the country. Without this, can these groups ever do what they originally set out to achieve?’ he asked the event called NHS in 2017: What Will be Different?
Dr Porter spoke of his concern about the marketisation of the NHS.
He said there had always been a role for the market in the NHS, such as the manufacture of drugs he used in his job as a consultant anaesthetist. However, he said there were real concerns about the emphasis on competition.
Focus on outcomes
‘When Woolworth’s closed in the middle of Coventry [customers] were a bit upset about it but there’s always another shop. But if the NHS closes in an area, there’s not another shop to pick up the associated services,’ Dr Porter said.
In a panel discussion following his speech, he said that there should be more of a focus on outcomes rather than activity in the NHS.
Fellow panellist, the Commons health select committee chair Stephen Dorrell, said he agreed, saying the focus should be on what the NHS achieved for its £120bn of taxpayers’ money.
Answering a question on the centralisation of services, Dr Porter said focussed outcomes needed to be considered in such decision-making.
He said, for example, the centralisation of services had worked for emergency vascular surgery because larger units had better survival rates.