London trusts overhaul primary care without consultation

BMJ 2007; 335 doi: (Published 01 November 2007) Cite this as: BMJ 2007;335:904
  1. Caroline White
  1. London

    Primary care trusts have already started implementing radical proposals for overhauling London's health services, despite the fact that these have not been put out to formal consultation, family doctors have claimed.

    The capital's strategic health authority, NHS London, recommended Ara Darzi's proposals to each of the city's 31 primary care trusts (PCTs) in August to give them time to work out the logistics of formal consultation (BMJ 2007;335:61 doi: 10.1136/bmj.39273.467697.DB).

    That process starts this month and runs until February. There will be further consultation on local plans.

    But at a meeting organised last week by the BMA's London Regional Council to discuss the proposals, several GPs, and a Pensioners Forum representative, claimed that their trusts had already started the ball rolling.

    These included earmarking buildings and land for polyclinics or supersurgeries, one of the most hotly debated of the six suggested models of healthcare delivery.

    Concerns were also raised that trusts were continuing to press ahead with service cuts and reconfigurations before the outcome of discussions on the proposals was known.

    “Every PCT is already looking at where their polyclinics are to be located,” said Chaand Nagpaul, a negotiator on the BMA's General Practitioners Committee, adding that this was distracting them from patient care.

    Bill Gillespie of NHS London reassured delegates that trusts would have to consult widely.

    “But that's not the reality on the ground,” said Dr Nagpaul. “Perhaps there is some work to be done telling the PCTs who are implementing already.”

    John Lister, information director for the pressure group London Health Emergency, was one of several doctors who picked numerous holes in Professor Darzi's calculations.

    These, he said, were based on very big assumptions, and contained “dodgy numbers” and “few hard facts.”

    “[They] aim to save £1.5bn [€2bn; $3bn] a year, but what about the costs of reorganisation?” added Dr Nagpaul. “And it has cost £1m to develop the proposals even before the consultation.”

    “There is no doubt of the good intentions behind this,” said Jacky Davis, consultant radiologist and a founding member of the Keep our NHS Public campaign. “But there is a real fear that [these] will be used by people who want to save money and get rid of services.”

    Quizzed by MPs on the Health Select Committee last week, Professor Darzi said that his framework for London had been informed by the views of 150 clinicians, most of whom had argued for a shift of services into primary care.

    “My aim was not to create a business case, but to create a vision document,” he said.

    “There will be a 700 000 growth in London's population over the next 10 years, with 47% more inpatient and 66% more [emergency care] appointments and a 77% increase in GP use,” he said.

    “We need to be smarter and more proactive. Otherwise the whole system will be paralysed,” he told MPs.


    • Views on the proposals can be submitted to hfl{at}

    View Abstract

    Sign in

    Log in through your institution

    Free trial

    Register for a free trial to to receive unlimited access to all content on for 14 days.
    Sign up for a free trial