Intended for healthcare professionals

Rapid response to:


Reorganisation of the NHS in England

BMJ 2010; 341 doi: (Published 16 July 2010) Cite this as: BMJ 2010;341:c3843

Rapid Response:

NHS Reorganisation: The Devil is in the Details

Kieran Walshe1 is entirely correct to point out the potential
problems with vast reorganisation of the NHS and the proposals in the
Government’s recent White Paper (Equity and excellence: Liberating the
NHS2) attract criticism for their expensive, top-down restructuring. There
is however, a great deal more to be concerned about after reading the
details of the Proposals – which set forward a flawed and potentially
dangerous plan for the provision of healthcare services in the NHS.

The creation of GP Consortia diverts GPs from their clinical role,
forcing them to take on complex management and accountancy responsibility
without adequate training. We should focus on GPs as clinicians with more
time to see patients, and to deal with them appropriately. Better trained,
more patient-focussed GPs will reduce NHS costs by reducing unnecessary
referrals and increasing the number of conditions handled in the primary
care setting. Accountability will also suffer: the public’s right to
change GP does not equate to holding Consortia accountable - the sum of
individual patient preference does not necessarily equal the best course
for public health as a whole.

In allowing “any willing provider3” to offer services to NHS
patients, the door is flung firmly open to private companies to compete
with the NHS. With Monitor enforcing competition law4 we risk creating a
two tier system of health-care for the healthy, where those lucrative
patients with minimal risks are skimmed off by the private sector, leaving
the now underfunded, pick-pocketed NHS hospitals straining under the
weight of the complicated and chronically sick. This pilfering of patients
from NHS hospitals will have knock-on effects for the future, since it is
the public sector which trains our junior doctors, and they who will miss
out as patients are diverted to private health companies.

Under the guise of public choice the White Paper also encourages
third parties (private companies) to provide information for patients5.
There are already private companies who will rank hospitals and the
services they provide for a fee - at present hospitals that do not pay the
fee do not receive the same opportunity to answer criticisms and correct
mistakes prior to ranks being published.

The focus on patient choice in the White Paper is to be applauded.
However it offers little in the way of how to improve patient involvement
in healthcare – it is doubtful that those sections of society that
currently take little interest in their own health, will be inspired to do
so simply by making more information available.

Reducing bureaucracy costs, encouraging of frontline staff to drive
improvements, and increasing information available to patients, are all
positive ideals that should be welcomed by all. However, the current White
Paper diverts GPs from their clinical role; allows slim-line private
providers to offer cheaper options and thereby pick-pocket NHS hospital
funds; increases reliance upon expensive and potentially flawed ranking
systems; and champions patient choice without setting a clear agenda for
improving patient involvement.

Yours Sincerely

Dr C Williams

University Hospital Lewisham

1 Walshe K, Reorganisation of the NHS in England. BMJ 2010, 341

2 Department of Health White Paper. “Equity and excellence: Liberating the
NHS” 12 July 2010, available from URL:

3 Department of Health White Paper. “Equity and excellence: Liberating the
NHS” 12 July 2010. Page 37, section 4.24. Available from URL:

4 Department of Health White Paper. “Equity and excellence: Liberating the
NHS” 12 July 2010. Page 38, section 4.27. Available from URL:

5 Department of Health White Paper. “Equity and excellence: Liberating the
NHS” 12 July 2010. Page 15, section 2.14 Available from URL:


Competing interests:
None declared

Competing interests: No competing interests

29 July 2010
Chris Williams
University Hospital Lewisham