NHS reforms may mean a drop in quality of GP services, warns watchdog

BMJ 2011; 342 doi: (Published 24 January 2011) Cite this as: BMJ 2011;342:d450
  1. Adrian O’Dowd
  1. 1London

The quality of service provided by GPs to their patients could drop as doctors struggle to adapt to their new commissioning role, England’s spending watchdog has warned.

In its new report the National Audit Office summarises the new arrangements for the NHS proposed by the government in the Health and Social Care Bill 2011, published on 19 January (BMJ 2011;342:d418, doi:10.1136/bmj.d418), and warns about their potential short term effect on the cost and quality of services. The report will inform the House of Commons Public Accounts Committee’s questioning of the Department of Health on 25 January.

The watchdog emphasises the scale of changes ahead, mentioning that more than 500 organisations are likely to be abolished or created or to have their functions changed and that more than 90 000 staff will be directly affected by the changes, with many more affected indirectly.

“Given the scale of the proposed reforms and the number of inter-dependencies between different parts of the system, the Department [of Health] faces a major challenge in ensuring coherence during the transition period, so that different rates of progress in different parts of the system do not adversely affect each other,” says the report, which adds that effective risk management will be crucial.

The National Audit Office had identified a number of “undesirable results” that follow from poor risk management—namely, poorly thought through plans, unrealistic timetables, weak controls, delays in delivery, and wasted money.

A key objective of the proposed reforms is to improve the quality of services offered to patients by the NHS, says the report. “However, during the transition process, there are a number of risks to service quality—for example, the risk that GP services to patients may decline as GPs focus on establishing commissioning consortia and getting to grips with their new commissioning role.”

The watchdog acknowledges, however, that the government had published an outcomes framework in December last year as one way of trying to ensure quality (BMJ 2010;341:c7354, doi:10.1136/bmj.c7354) and that it planned to continue the main existing quality programme, called Quality, Innovation, Productivity and Prevention (QIPP), during the transition.

The direct costs of the NHS reforms are estimated by the health department to be around £1.4bn (€1.6bn; $2.2bn), including redundancy costs, information technology, and “double running” of organisations during the transition process.

The department expects the reforms to deliver a 33% reduction in administration costs by 2014-15 and £11.8bn worth of direct benefits over 10 years.

However, the watchdog adds another note of caution, saying that its previous studies of other major reorganisations of government had found “recurring issues of weak cost control.”


Cite this as: BMJ 2011;342:d450