A bill is due to be published to pave the way for an overhaul of the NHS The upheaval in the NHS in England is unnecessary as the same results could have been achieved by a small change in the current structure, leading GPs say.
Ministers will publish a health bill this week that will pave the way for GP consortiums to take over management of the NHS from primary care trusts.
But the Royal College of GPs’ Dr Clare Gerada and Dr Laurence Buckman, of the British Medical Association, said GPs could have been put in charge of PCTs.
The government rejected the suggestion.
Nonetheless, their intervention is set to spark another round of debate over the government’s controversial plans.
It comes a day after the Observer reported that a report from the NHS Confederation, which represents bodies such as foundation hospitals, primary care trusts and doctors’ groups, suggested hospitals may have to close under the planned reforms.
Among its criticisms, it said allowing GPs to commission services from what it called “any willing provider”, could mean the closure of some hospitals and facilities in order to make way for new private providers.
Ministers have already started piloting GP consortiums, which will take responsibility for spending 80% of the NHS budget in England by 2013. In the process, 151 primary care trusts will be scrapped.
The plans have been criticised at a time when the NHS is having to make savings.
The budget is rising slightly in the coming years, but not enough to keep pace with the rising costs.
The alternative option being put forward by GPs involves the key decision-making body for PCTs, the board.
These tend to have 13 representatives, a majority of which are members of the public. There is only a requirement for them to have one GP, although some have two or three.
Boards have to sign off all big decisions, such as setting up new services.
“You could have simply mandated to ensure GPs had more of an influence on PCT boards – and achieved largely the same results”
Dr Clare Gerada Royal College of GPs
The two GP leaders believe by putting more doctors on the board, the government would have been able to achieve its key aim of getting doctors more involved in decision-making.
Dr Gerada, the chairman of the Royal College of GPs, said: “You could have simply mandated to ensure GPs had more of an influence on PCT boards – and achieved largely the same results. You would probably want a majority of clinicians, mostly GPs but other NHS staff too. It is not too late to change.
“By doing that GPs would have become heavily involved in making the decisions, we could have still made management savings, but without all the upheaval that the NHS is going through.”
Dr Buckman agreed: “We have chaos in management in the health service and that would have been avoided. It could have been that simple.”
However, he believes the ultimate aim is to open the NHS up to the private sector. “By setting up consortiums it gives the impression that decisions are being taken further away from the centre.”
David Stout, director of the PCT Network, said the idea could have worked.
“PCTs were improving all the time and could have adapted. It could have been another option, but it is too late now.”
A Department of Health spokeswoman said: “Primary care trusts are too remote from patients.
“Simply putting more GPs on a PCT board would not have delivered the changes that are necessary, and would have simply added more layers to the existing NHS bureaucracy.
“Commissioning by GP consortia will push decision-making much closer to patients and local communities and ensure that commissioners are accountable to them.”
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