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BMA warns government control over GP consortiums will be too powerful

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1343 (Published 01 March 2011) Cite this as: BMJ 2011;342:d1343
  1. Adrian O’Dowd
  1. 1London

Claims that doctors will have real control of the new commissioning consortiums to choose services for patients are fatally undermined by “overly restrictive and controlling” powers held by government, claim doctors’ leaders.

The BMA has raised concerns that under the planned reforms of the NHS, health secretary Andrew Lansley and the NHS Commissioning Board overseeing the GP consortiums will have too much control.

In a new briefing issued on 28 February, the BMA said some of the legislation in its current form went against government pledges to put doctors “in the driving seat” and could prevent them from delivering improvements to patient care.

The briefing A genuine devolution of power? has been timed to raise these issues while the Health and Social Care Bill (for England) is being scrutinised by MPs on the Parliamentary Bill Committee before it goes back for debate in the House of Commons.

When the health white paper Equity and Excellence: Liberating the NHS was published in July last year (BMJ 2010; 341:c3796 doi: 10.1136/bmj.c3796), it promised that reforms would devolve power to consortiums and give them freedom to decide what services they would commission.

The BMA, however, has studied the wording of the subsequent bill and in its new briefing said “the reality does not match the rhetoric.”

The NHS Commissioning Board will not be able to operate autonomously and free from political control, said the BMA, and the health secretary would be able to impose any conditions on consortia without review.

The briefing accepts that although there may be occasions, such as during a public health emergency, that the health secretary would need to direct from the centre, the bill’s current wording is too broad.

The health secretary could remove or suspend a non-executive member of the NHS Commissioning Board whenever he wanted and force the board and consortiums to arrange treatments and services in a way that he specified.

Another concern held by the BMA is that the NHS Commissioning Board’s powers would mean it could dismiss a consortium’s accountable officer (the equivalent role to a chief executive of a primary care trust) and bring in a replacement.

In addition, the NHS Commissioning Board would be able to dissolve consortiums and change consortiums’ areas without consultation and the briefing says: “We think the Board’s powers are too draconian as it stands.”

Laurence Buckman, chairman of the BMA’s GPs committee, said: “The NHS Commissioning Board will be given sweeping powers to get involved with the way consortia operate.

“Time and time again in the bill we see no mention of the need to consult consortia on matters that will have a direct and potentially very significant impact on the way they operate.

“We are very concerned about how restrictive the Bill is and want to see that, at the very least, there is a duty to consult consortia written into the legislation.”

Health minister Simon Burns dismissed the BMA’s concerns, saying: “This is nonsense. The Bill gives GPs power to purchase and design services on behalf of their patients in a way that isn’t possible at present.

“It also restricts, for the first time, the discretion of ministers to interfere in day to day decisions in the NHS. And it places new legal duties on the Secretary of State and the NHS Commissioning Board to promote autonomy and minimise administrative burdens on the NHS.”

Notes

Cite this as: BMJ 2011;342:d1343

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