An overhaul of the NHS was announced in July The forthcoming shake-up of the NHS in England could undermine its “stability and future”, doctors’ leaders say.
The British Medical Association warning sparks the start of what promises to be a delicate balancing act for ministers.
The government set out plans in July to give GPs control of much of the budget, while scrapping two tiers of managers.
The BMA said it was not against the whole vision, but it had “fundamental” concerns.; the government says the changes will help improve the service.
The BMA’s criticisms – made in its official response to July’s white paper – contrast with its initial response over the summer when it said it was “ready, willing and able”.
And they come as the government faces a legal challenge from the union Unison.
The public sector union is seeking a judicial review over the way the government is handling the changes.
The official consultation period will end later this month, after which ministers are likely to start formal talks with BMA negotiators about implementing the changes.
It wants to start piloting the GP consortiums, which will take charge of the budget from the soon-to-be abolished primary care trusts, this financial year. Full roll-out will follow within two years.
But it is this pace of change which is one of the problems, according to the BMA.
It said the timetable could threaten the £20bn savings the health service has to make by 2014.
The BMA also took issue with the “obsession” with competition, saying GPs would be set against hospitals – one of the objectives of the changes is to get more care done more cheaply outside hospitals.
Many doctors also fear the plans will lead to the increased involvement of the private sector – and ultimately damage the doctor-patient relationship as the public could start viewing their own GPs as rationers of services.
The BMA said there needed to be a clear distinction between individual GPs and the consortiums.
Dr Richard Vautrey, deputy chairman of the BMA’s GPs committee, conceded the majority of family doctors had “concerns”.
The BMA is probably one of the most powerful professional bodies.
But it has carefully positioned itself above the normal rough and tumble of the labour movement.
In fact, it is just as likely to throw its weight around in debates about drinking and science as it is over pay and conditions.
And with close links to influential voices across the political spectrum, it has a significant power-base.
But that does not mean it has a veto on these changes.
While the government is likely to seek formal talks soon, ministers could force through the plans if they wished.
Of course, that would create resentment within the profession and for the reforms to work the government needs doctors on side.
Instead, expect a long and drawn out period of negotiations, claim and counter claim with today’s intervention just the start.
The document said issues such as these had the “potential to undermine the stablility and long-term future of the NHS”.
BMA chairman Dr Hamish Meldrum added: “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.”
Shadow health secretary Andy Burnham said: “This backs up Labour’s warnings since the white paper was published.”
And Jennifer Dixon, chief executive of the Nuffield Trust, a health think-tank, suggested the BMA was right to highlight some of the issues.
“The reforms are substantial and will require significant management expertise to implement smoothly. A real concern is whether this level of reform can be implemented without risk of major failure.”
But she also questioned whether GPs were ready to take on the budget, likening it to local convenience stores trying to become the Tesco of the health service.
Health Secretary Andrew Lansley played down the criticisms.
“There are many GPs across the country who are keen to make the transition quickly, others want to know more about how it’s going to work before they implement it,” he said.
“This is what the consultation process is about, everyone coming forward to say how can we make this work.”
He added that the plans were aimed at making care better for patients.
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