Primary care trusts are likely to “implode” before new structures are in place, doctors’ leader says

Primary care trusts are in danger of “imploding” long before the deadline for their abolition, the chairman of the BMA GPs’ committee told a conference in London.

Expressing fears that the government’s reforms of the NHS in England were going faster than had been intended, Dr Laurence Buckman said that PCTs were in danger of losing their best managers before their formal abolition in 2013.

These managers were needed to make a success of GP commissioning, the cornerstone of the reforms. “We should have done it at a slower pace but I expect it will be a lot faster,” he said. “What worries many of us is seeing good managers made to feel they should flee. They will be needed and the very great majority have done a good job.”

Speaking at a Westminster Health Forum seminar on the future of the NHS after the white paper, Dr Buckman was upbeat about GP commissioning. He believed there were enough enthusiasts for the idea among GPs to make it work, although he warned against “enthusiasts without a mandate” taking over the running of consortiums. The BMA has said that the leaders of consortiums should be elected by the members.

Dr Buckman identified several areas that still needed clarification, including what would happen when hospitals or consortiums ran out of money. “The government has said it will not bail out organisations that fail. But what does that translate into—patients turned out on to the streets? He was also anxious about consortiums taking over inherited debts from PCTs, and the possibility of “internal health tourism” if consortiums differed in their approach.

Given that patients will be free to register anywhere, “there could be a run on consortiums that provide Viagra,” he said.

“I would like this enormous experiment to work, but I’m not sure it will,” he concluded. “It’s meant to be about reducing bureaucracy, but can we avoid recreating the PCTs? I’m not so sure.”

Dr Clare Gerada, chair elect of the Council of the Royal College of General Practitioners, was markedly cooler. While she did not doubt GPs’ capacity to take on the task, asking them to do so missed the point. “GPs are not that interested in commissioning,” she said. “We are doers and what we want to do is care. What would genuinely have been a revolution would have been to develop integrated care organisations.”

Derek Twigg MP, shadow health minister, and Karen Jennings of Unison both attacked the changes. The government had broken its pre-election promise not to have a top-down reform of the NHS in England, Mr Twigg said, and GP commissioning was a huge change and a massive risk while the NHS was facing cost pressures.

Ms Jennings warned that “a real conflict was brewing” over job losses, and that it was time to stop the “shameful stereotyping of managers.” The changes were progressing at breakneck speed and would cost £3bn (€3.5bn; $4.9bn) at a time when a tiny rise in funding would be wiped out by inflation and £1bn had been taken out of the NHS budget to fund social care. “Why are we doing this?” she asked of the white paper reforms. “It doesn’t make sense.”

Dame Barbara Hakin, national managing director of commissioning development at the Department of Health, said the reform timetable had been careful, but things were now moving fast. Pathfinder commissioning groups had been set up, and there would be more in the new year, operating with authority delegated from the PCTs.

“People are now going off to join the new thing” she said. “But even if the timetable had been longer, that would have happened.”