Reforms like 'tossing a grenade into the NHS'

Andrew Lansley's 'surprise' reforms have already damaged clinical decision-making and increased costs, the Health Select Committee has reported.

Dr Wollaston: the effect of announcing the abolition of PCTs and SHAs had been like someone tossing a grenade into the NHS
Dr Wollaston: the effect of announcing the abolition of PCTs and SHAs had been like someone tossing a grenade into the NHS

Committee member, Conservative MP and GP Dr Sarah Wollaston said the effect of announcing the abolition of PCTs and SHAs had been like ‘someone tossing a grenade’ into the NHS.

The cross-party committee published its report Commissioning after looking into the current NHS system and the health secretary’s White Paper plans. 

The report acknowledges there is a need for commissioning reform. But it is critical of how the policy ‘shifted’ after the coalition was formed, with the abolition of PCTs and SHAs being announced without warning.

The report says the 'uncertainties' created by the White Paper would 'almost certainly have added both to the direct cost of the transition, as well as the indirect costs incurred as a result of poor decision making by commissioners'.

Stephen Dorrell MP, committee chairman and former health secretary, said the principles of the reform were the right ones but that Mr Lansley's plans for the transition had ‘not been the most efficient way to go about it.’

He urged the health secretary to be clearer on the scale of the reforms. He highlighted the fact that Mr Lansley had told the committee the plans were ‘not an upheaval,’ but NHS chief executive Sir David Nicholson described the change as ‘enormous – beyond anything anybody from the public or private sector has witnessed'.

The committee will launch a range of reviews into each area of concern it has with the commissioning reforms.

One review will look at how GPs can influence and commission primary care while avoiding conflicts of interest. The committee will also investigate whether competition law will stifle commissioners under the 'any willing provider' policy set out in the White Paper.

‘The most extreme example is that a GP is concerned that talking through options with his local hospital is seen as anti-competitive,’ said Mr Dorrell.

He said more should be done to integrate the ‘entire clinical community’ into commissioning consortia, ‘not just GPs.’

Despite the criticism, the move towards GP commissioning is seen by the committee as the best way of finding the ‘unprecedented’ £15-20bn savings the NHS requires, now dubbed ‘The Nicholson challenge' by MPs.

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