THE mounting anger of GPs and consultants over the Lansley NHS White Paper has forced the British Medical Association (BMA) Council to retreat from its earlier position of unconditional support for the Coalition health document.
A BMA statement yesterday said that ‘positive elements of the government’s plans for the NHS in England – such as devolving more control to patients and frontline clinicians, and a stronger focus on public health – are at risk from other aspects that seek to accelerate a market-based approach.’
In its just-published response to the White Paper, the BMA said it is ‘interested in exploring proposals for most services to be commissioned by consortia led by GPs’.
However, it warns that ‘proposals that would encourage further competition in the NHS – such as extending choice to “any willing provider” and giving the foundation trust regulator Monitor a duty to promote competition – would risk shifting the focus onto cost rather than quality, and would undermine opportunities to work more collaboratively across primary and secondary care.’
Dr Hamish Meldrum, Chairman of Council at the BMA, said: ‘There are proposals in the White Paper that doctors can support and want to work with.
‘But there is also much that would be potentially damaging.
‘The BMA has consistently argued that clinicians should have more autonomy to shape services for their patients, but pitting them against each other in a market-based system creates waste, bureaucracy and inefficiency.’
The BMA response adds that ‘protection of national terms and conditions is essential to ensure an equitable spread of staff across the UK.’
It also ‘expresses serious concerns about the determination for all trusts to have foundation status by 2013-14’.
The BMA ‘questions whether there is any evidence that significant numbers of staff wish to work in social enterprises, and urges caution in changing the ethos of NHS provision’.
BMA Council member Anna Athow, who is opposed to the White Paper, commented: ‘The BMA’s press statement wants it both ways on the White Paper (WP )
‘It recognises that there are “aspects that seek to accelerate a market-based approach”.
‘It says that “proposals that would encourage further competition in the NHS” would be risky and that “there is also much which is potentially damaging”.
‘At the same time, it says it is “interested in exploring proposals for most services to be commissioned by consortia led by GPs”.
‘It fails to warn that in fact these would not be led by GPs, but by a clique who did the commissioning for them, which would more and more involve large commercial companies.
‘Yet, GPs would nominally have to take responsibility for commissioning £20bn less NHS services and savagely closing hospitals and reducing care to patients.
‘It fails to point out that the National Commissioning Board and the GP commissioning consortia (GPCCs) have been instructed to rapidly increase “patient choice”, meaning the outsourcing of NHS clinical work to private companies.
‘It is through the privatisation of commissioning and provision of NHS care, that the market, which the BMA says it does not like, will become a reality.
‘By suggesting that the WP consists of good and bad proposals, some of which can be accepted, the statement in effect, goes along with the changes albeit with caveats.
‘The BMA leadership knows that the WP prefaces legislation which would end the NHS as a publicly provided service.
‘This “curate’s egg” acceptance approach is a rejection of the BMA’s campaign to Look After Our NHS as a publicly funded and provided service and should be abandoned forthwith. It is urgent that a recall conference of the membership is called to discuss and vote on this issue.’
The government yesterday afternoon rejected the BMA’s warnings and said that it was right to proceed with the reforms.
