NHS 'urgently needs decisions to avoid disarray'

NHS logo The NHS reforms are on hold

The NHS in England needs rapid decisions on the health bill to avoid disarray, doctors and managers say.

The NHS Confederation and British Medical Association said uncertainty after the plans were put on hold may even put savings targets in jeopardy.

It comes as the government is discussing making wide-ranging concessions.

But, in a boost to ministers, GPs piloting the changes have urged them to press ahead.

More than 40 GPs already working in consortia, which, under the plans, will get control of most of the NHS budget from 2013, wrote a letter published in the Daily Telegraph which said the reforms were needed to improve patients care.

The Telegraph letter's lead signatory is Dr Jonathan Munday, chairman of the Victoria Commissioning Consortium, and a former Conservative councillor and mayor.

Echoing earlier comments by Prime Minister David Cameron, they said the reforms were "not revolutionary but an evolution".

Competition

The government put the progression of the health bill in parliament on hold last month to carry out a listening exercise.

Some have described the move as a PR exercise and Labour leader Ed Miliband once again used Prime Minister's Questions to criticise the government's handling of the NHS.

He said the promise to listen to concerns about the proposals was a "sham" and said the "failing" reforms were Mr Cameron's fault.

But the Prime Minister said "significant and substantial" changes would be made.

The BBC understands one solution being seriously considered is to keep remaining primary care trust clusters beyond 2013 to give GP consortia support.

Scrapping PCTs is one of the controversial elements of the programme as it was not part of the Tory manifesto or coalition agreement.

Since the plans were announced the number of PCTs has shrunk rapidly from more than 150 to just over 50 clusters.

Possible concessions

  • PCT clusters may be kept to give support to GP consortia
  • GP consortia membership to be widened to include groups such as nurses
  • Greater clarity on competition, setting out limits to private sector involvement
  • Duty of the regulator Monitor to promote competition may be dropped
  • The 2013 deadline for implementation to be relaxed

This still leaves the politically charged issue of competition to be resolved. Some experts believe this could be addressed by defining in more detail the role of the economic regulator Monitor, and strengthening reassurances about the need for collaboration with the the health service.

Concessions have already been signalled over the price and cherry picking by private firms, but further announcements over the extent to which the NHS is being opened up to competition law can be expected.

Other key areas include whether the make-up of GP commissioning groups could be widened to include other groups, such as nurses.

The government is expected to announce the results of its listening exercise in June.

Nigel Edwards, of the NHS Confederation, which represents managers, said it could not come soon enough. "The NHS has an incredible capacity for change, and the system goes into overdrive. So much is happening already that decisions need to be made rapidly, ideally before September."

Stephen Dorrell, a Tory MP and chairman of the health select committee, said there was no reason why the key principles of the plans should not survive as they were in line with "most of the key ideas" of the last 20 years.

Instead, he said he expected to see changes in emphasis and presentation as well as greater clarity over issues such as accountability.

He added: "I hope what we will see is a bill which is accurately targeted at the problems. That is managing demand for health care against a backdrop of tighter finances and changing patterns of need in the community."

But in a sign of the difficulty facing the government in its attempts to get consensus Richard Vautrey, of the BMA's GP committee, suggested the government may have to start again.

"Withdraw the bill, reframe it and return it to parliament once you have the support of the profession. It is a mess. Valuable, talented managers are already jumping shift. We have to be mindful the NHS has to make significant savings so more than anything the NHS needs clarity."

A Department of Health spokesman said: "We remain committed to the principles of our plans and improvements will be made as we listen, including to the views of those within the NHS."

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