Accountable care organisations (ACOs) threaten to change key aspects of the NHS and might lead to the privatisation of planning and limitation of the scope of NHS services. I explained the risks of ACOs in a previous article on GPonline earlier this year - and they are now coming closer.
A government consultation on introducing regulatory, contractual changes to usher in ACOs and accountable care systems closed earlier this month. The consultation document suggests these changes are relatively minor, technical amendments to the NHS standard contract - for example to enable GMS and PMS practitioners to participate in an ACO by suspending their current contracts, with a mechanism allowing them to reactivate them at a later stage if they wish.
However, these new powers, as explained by campaigners Dr Colin Hutchinson, Professor Allyson Pollock, Professor Sue Richards and Dr Graham Winyard, could produce major and radical re-organisation of the NHS in England, covering who makes decisions about the provision of healthcare, who has the power to change the scope of healthcare services, and ultimately to decide what the NHS provides for free in parts of the UK.
What is an ACO?
The consultation document offers very limited information about the meaning, purpose and effect of ACOs. Proposed regulations set out in the consultation describe ACOs opaquely as 'a body known as an accountable care organisation having been so designated by [NHS England] because it is providing or arranging the provision of health services under the National Health Service Act 2006 which are referred to in a contract based on a standard contract, developed by the Board, for accountable care models'.
Campaigners are concerned that the recent consultation would make any later formal consultation - on changes that could have a profound impact on the NHS - meaningless. Once the ACOs are in place, there is little point in consulting on them.
NHS England does not have the power to issue or impose an NHS standard contract without first consulting - which it plans to do in 2018. The quartet of campaigners above point out that the law says consultation must be 'undertaken at a time when proposals are still at a formative stage; it must include sufficient reasons for particular proposals to allow those consulted to give an intelligent response…and the product of the consultation must be conscientiously taken into account when the ultimate decision is taken'.
But amendments to the regulations under the consultation that has just closed could enable the formation of ACOs straight away, without the full debate changes of this magnitude deserve.
The loose definition provided in the consultation suggests that ACOs could be run by private companies, despite private involvement in the NHS to date often proving problematic. For example, the BMA warned this month that problems with the outsourced primary care support service run by Capita continues to cause problems for GPs - more than a year after an official user satisfaction survey found that only one in five GPs were satisfied with the service.
Meanwhile, research published this month found that GP practices run by private companies are worse for patients.
Working with public law firm Leigh Day, the campaigning group 999 Call for the NHS believes that the proposed changes to regulations to facilitate ACOs are unlawful under current NHS legislation and could make rationing in the health service worse and has called for a judicial review.
Allyson Pollock and colleagues have also called for a judicial review challenging the government over its duty properly to consult the public over the proposals.
Both groups of campaigners share the following aim - we want the proposed regulations to be withdrawn and not laid before parliament until after a lawful consultation on the principle of ACOs has been conducted.
- Dr Brian Fisher is a GP in London and honorary vice president of the Socialist Health Association