Plans for NHS in England an unholy mess, say journals

Nurses using a hand held computer (Photo SPL) The new system could 'go live' in April 2013

Changes to the NHS in England have created an "unholy mess", the editors of three leading journals have said.

With the overhaul just over a year away, the joint editorial by the Health Service Journal, Nursing Times and British Medical Journal acknowledged it was unlikely it could be stopped now.

But it predicted the changes would be so destructive another reorganisation would be needed within five years.

And it urged politicians to learn from the mistakes that had been made.

The opinion piece, which will be published in the three magazines this week, suggests an independent commission be set up to oversee changes in the future.

The intervention by the journals comes after the major NHS unions have called for the bill underpinning the changes to be scrapped.

Last week the medical royal colleges, which set standards in the NHS, nearly joined them in opposing the plans, before deciding against the move following last-minute pleas by ministers.

It means if the bill completes its passage through Parliament in the coming months the new system will go live in April 2013.

'Hasty compromises'

Under the plans, groups of GPs will take charge of much of the NHS budget from managers working for primary care trusts, while more competition with the private sector will be encouraged.

The editorial said the changes had been "unnecessary, poorly conceived and badly communicated" and had "destabilised and damaged" the health service.

It said through a combination of hasty compromises, a lack of confidence among staff and badly drawn-up proposals, the new system would be "unstable".

Start Quote

It could still create a coherent system, but we must give GPs the freedom to make a difference”

End Quote Dr Michael Dixon Clinical Commissioning Coalition

Dr Fiona Godlee, editor-in-chief of the BMJ, said the journals had decided to make what she said was an unprecedented step of issuing a joint editorial to illustrate the depth of feeling within the health service.

"We don't represent anyone, but we do talk to the doctors, nurses and managers who will have to implement these changes and wanted to get across the sense of anger at what has happened."

Dr Michael Dixon, of the Clinical Commissioning Coalition - which represents GPs who are piloting the changes - said he did not share the sense of gloom expressed by the editorial.

He acknowledged there were problems with how the changes were being rolled out, particularly over the powers being given to the national board, but accused critics of having "vested interests".

NHS reforms timeline

  • July 2010 - White paper published setting out plans, which involve giving GPs control of the budget, while encouraging greater competition.
  • January 2011 - Bill underpinning the changes gets its first readings in the House of Commons.
  • March 2011 - Lib Dem spring conference votes for radical change to "damaging" plans amid mounting concerns among health groups.
  • April 2011 - Bill paused so that government can carry out a two-month "listening exercise" to address criticisms.
  • June/July 2011 - Listening exercise leads to a series of changes to the bill, limiting competition and improving accountability.
  • September 2011 - Bill makes it to the Lords, leading to more amendments being tabled. Expected to return to the Commons in spring 2012.
  • October 2011 - National board established in shadow form to oversee new system as groups of GPs start piloting new arrangements.
  • April 2013 - Board and GP groups to formally take control of the system.

He added: "It could still create a coherent system, but we must give GPs the freedom to make a difference. There is a unique opportunity here, we must make sure we grab it."

A spokesperson for the Department of Health said: "Our reforms are based on what NHS staff themselves have consistently said - they want more freedom from day-to-day bureaucracy and political interference so they can get on with the job of caring for patients. That is exactly what this bill achieves.

"Through the independent NHS Future Forum we have already had hundreds of meetings, discussions and public debates with thousands of people on the future of the health service.

"To start this process again would undermine the development of clinical commissioning and prevent healthcare professionals taking decisions in the interests of their patients.

"The Future Forum demonstrated widespread agreement with the principles of change and GPs themselves have written to newspapers to express their support.

"It's completely untrue to suggest that dropping the bill would save the NHS money.

"Our plans will reduce needless bureaucracy by a third and save £4.5 billion over the course of this Parliament and £1.5 billion every year afterwards. Every penny saved will be reinvested in frontline care for patients."

Release of the editorial comes as a study published by BMJ Open - part of the British Medical Journal group - claimed that GPs were at high risk of burnout.

The report, based on a survey of 564 GPs, found they were suffering from high levels of emotional exhaustion and a reduced sense of personal accomplishment, particularly those who repeatedly saw the same patients.

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