Intended for healthcare professionals

Feature Round Table

“We need to ‘shake’ the bill to make sure it works for patients”

BMJ 2011; 342 doi: (Published 14 March 2011) Cite this as: BMJ 2011;342:d1637
  1. Rebecca Coombes, features editor
  1. 1BMJ, London WC1H 9JR
  1. rcoombes{at}

Last week the BMJ brought together a group of influential clinicians and thinkers in UK healthcare to discuss the radical changes afoot in the NHS. Rebecca Coombes summarises the key points. You can also listen to edited highlights in a BMJ podcast (

Major changes to the English NHS, as set out in the Health and Social Care Bill 2011, are currently under scrutiny by parliament. A complete middle tier of NHS management is being swept away—primary care trusts, currently a major commissioner of services, and strategic health authorities will be gone by 2013. Instead consortiums of general practitioners are to receive 80% of the healthcare budget—around £80bn (€95bn; $130bn) with a remit to tender services to “any willing provider” that can offer the best quality service locally.

The BMJ brought together a panel to discuss the health service view of these changes. The panel was made up of Michelle Drage, chief executive of BMA London-wide local medical committee and a general practitioner; Clare Gerada, chair of the Royal College of General Practitioners; John Black, president of the Royal College of Surgeons; Anna Dixon, director of policy at the King’s Fund, a health thinktank; and Nigel Edwards, acting chief executive of the NHS Confederation, which represent managers.

Around the table, talk was about how GPs still feared domination by provider hospitals and anxieties about how doctors would be able to judge which services to buy based on clinical quality, when outcomes are notoriously difficult to measure. There was agreement that although the reform programme was designed on the basis that “small is beautiful,” actually some health services, such as for cancer, clearly worked best on a macro level. But would any of these changes tackle the widening inequalities in health in England? Panellists also mulled over the future of …

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