“We will stop the top-down reorganisations of the NHS that have got in the way of patient care.” Sound familiar? These words are from the coalition’s “programme for government”, published in May.
It therefore came as something of a surprise that, less than two months later, the same government’s white paper on health announced plans to abolish primary care trusts and hand £80bn of public money to GP-led consortia, overseen by a central NHS Commissioning Board.
Andy Burnham said the “dangerous plans represent one of the biggest and quickest U-turns in political history”. Ministers countered that the white paper is consistent with the aims outlined in the May programme because this is not a “top-down” diktat, but “bottom-up”, with control being handed to the frontline.
Volte face or not, the white paper does represent a radical reorganisation. Even practice managers hardened to reform have been astonished at the extent that the landscape of primary care is now set to change. Many support this bold move to clinical empowerment and the removal of what’s seen as unnecessary bureaucracy. Others reject it outright.
A report analysing the impact of previous structural reorganisations by Nigel Edwards, Director of Policy at the NHS Confederation, was published just before the white paper, clearly written in nervous anticipation of changes from the new health secretary. The report, The Triumph of Hope over Experience, argues that “there is good reason to suppose restructuring will have some adverse effects, may fail to deliver the promised benefits and may be carried out in haste or with insufficient thought, leading to further reorganisations later.”
Since Mr Lansley has shadowed his new role for six years it is unlikely that the white paper was thought out in haste. However, its reliance on clinical commissioners could be something of a gamble, especially in the current financial climate. James Gubb, Director of the health unit at Civitas, said that “now is not the time for ripping up internal structures yet again on scant evidence.”
Members of the public were also surprised by the white paper, as anyone who saw the BBC’s Question Time the week of its launch will not need reminding. The majority of the audience appeared hostile to the changes, with one member arguing that, since there was no mention of this in any party manifesto, there was no mandate for the proposals.
The “mandate” issue could have some way to go before it is settled. At the end of August, the union Unison applied for a judicial review to challenge the white paper proposals, after a letter from NHS Chief Executive Sir David Nicholson instructed health chiefs to begin implementing the proposals “immediately”. Unison argued this instruction was unlawful as the consultation had not concluded.
So the furore is far from over, even if practice managers have accepted the reality of the situation. Comments we’ve received on the MiP website suggest that most of you support the thrust of the white paper. “Trust at last is being returned to the professionals, so we should rise to the challenge and seize the opportunities with enthusiasm,” said Kate Harlow, a practice manager from Tunbridge Wells.
Mr Lansley has indeed put his trust in GP commissioning consortia, and simply in terms of goodwill there is no doubt this trust will be amply repaid. But in swiftly reversing the “no top-down reorganisation” promise, our new political masters may find less trust is returned to them.
Speaking of reorganisation, regular readers may have noticed that I’ve been “promoted” from the back page, among other changes. Foremost among these is the introduction of our new GP Business supplement, which I hope you’ll pass on to your doctors. This new short magazine provides GPs with news, information and a special focus from leading figures on one key topic each issue. We kick things off with a look at revalidation, with practical advice on how GPs can prepare for yet another key change. Management in Practice magazine will continue to focus exclusively on practice management, so I hope both publications will provide support to each profession at this crucial time for the frontline.