The controversial Health and Social Care Bill has been published, paving the way for GPs to control 80% of the NHS budget from 2013.
Unions warn the plans are the first step towards privatising the health service, while the health select committee said the way they have been rushed in has taken the NHS by “surprise”.
But the government argues the changes will improve care and accountability.
The plans will lead to the scrapping of PCTs and SHAs, GPs taking responsibility for commissioning and a greater role for private and voluntary sector providers in delivering services.
Health Secretary Andrew Lansley said: “In order to meet rising need in the future, we need to make changes. We need to take steps to improve health outcomes, bringing them up to the standards of the best international healthcare systems, and to bring down the NHS money spent on bureaucracy.
“This legislation will deliver changes that will improve outcomes for patients and save the NHS £1.7 billion every year – money that will be reinvested into services for patients.”
The BMA described the Bill as a massive gamble.
Dr Hamish Meldrum, the BMA’s chairman of council, said: “Ploughing ahead with these changes as they stand, at such speed, at a time of huge financial pressures, and when NHS staff and experts have so many concerns, is a massive gamble.
“We support greater involvement of clinicians in planning and shaping NHS services, but the benefits that clinician-led commissioning can bring are threatened by other parts of the Bill. In particular, the legislation will allow competition to be forced on commissioners, even when they believe the best and most appropriate services can be provided by local hospitals.”
Earlier this week, the Commons health select committee criticised the scale and speed of the reforms, saying the NHS had not been able to plan properly.
While the cross-party group acknowledged there is a need for commissioning reform, it said the way reform is being introduced would ‘almost certainly have added both to the direct cost of the transition, as well as the indirect costs incurred as a result of poor decision making by commissioners’.
The Bill says reform will cost £1.5bn to implement.
Sir Richard Thompson, president of the Royal College of Physicians, expressed concern that the Bill does not require specialists to be at the heart of the commissioning process.
He said: “The scale and pace of change – and the challenge of unprecedented efficiency savings – should not be underestimated. Neither should the risks if we get this wrong. We are also anxious to ensure that the system builds in effective safeguards to protect against service fragmentation. The fragmentation of services would have detrimental impacts on the very areas the reforms seek to improve: the quality of services, education and training, patient choice, efficiency and equity.”
The Bill suggests the NHS Commissioning Board will have significant powers over GP consortia, allowing it to determine their shape and structure and parachute in alternative providers, such as private companies, to help run those that are failing.
Dr Laurence Mynors-Wallis, registrar of the Royal College of Psychiatrists, said: “We are particularly concerned that in some areas the new structures will not have the skills or expertise to support mental health commissioning. We therefore believe, along with all the other medical royal colleges, that commissioning must involve a close working relationship between GPs and specialists.
“There is a danger that, in the new system, services will go to the cheapest provider at the expense of quality. There is also a danger that, if a multiplicity of providers are delivering different aspects of care, that care may be fragmented and patients may fall between gaps in services.”
There are now 141 groups of GP practices involved in the pathfinder commissioning pilots.
Read all 367-pages of the Health Bill.
Mike Broad is the editor of HospitalDr.co.uk, an independent news service covering the National Health Service. His posts appear in the pages of THCB by agreement.