In a response to the ‘Equity and Excellence: Liberating the NHS’ White Paper, the BMA said more thought needs to be given to the implications of expelled practices and how it would be practical for them to become part of another group if there was no other geographic, local authority or health economy link.
It also warned against consortia freezing out practices with high referral costs because of fears they will damage the consortia's performance on paper.
It said instead practices should be discussing what formations will make the most sense with regard to ‘natural clinical communities’.
Overall, the BMA said while there are elements of the White Paper that it ‘broadly supports’, there are aspects of the proposals that could potentially ‘undermine the stability and long-term future of the NHS’.
The BMA questioned the ‘value for money’ of the NHS reforms and suggested a ‘less disruptive, more cost-effective process’ could have been used to achieve similar goals.
It said the aims of the White Paper of increased clinical engagement and reduced bureaucracy could be achieved without a wholesale reorganisation of the NHS, which it said will cost a ‘large amount of money’ at a time when attempts are being made to release £15-20bn of efficiency savings.
The response said: ‘This is a very difficult climate in which to make substantial services changes and reconfigurations.
‘We urge the government and NHS organisations to focus on those areas where they can truly eliminate waste and achieve genuine efficiency savings rather than adopt a slash-and-burn approach to healthcare with arbitrary cuts and poorly considered policies.’
The BMA also warned of the potential to create a ‘vacuum’ in PCTs if skilled managers and staff leave their jobs.
‘If handled poorly, there is a real risk of PCT implosion, which would require a dramatic shortening of the proposed timeline, even if consortia were not fully capable of stepping into the role,’ the BMA said.
It also called for further detail on how PCT debts will be managed. Recent research by The Guardian found a third of PCTs had deficits at the end of 2009 totalling around £130m.
The BMA is keen to assert that these debts should not be passed onto consortia, as this would prevent groups from functioning to their full potential and also discourage GPs from becoming involved in consortia, it said.
Dr Hamish Meldrum, BMA's chairman of council, said: 'There are proposals in the White Paper that doctors can support and want to work with. But there is also much that would be potentially damaging.
'Doctors want to build on the founding principles of the NHS and to maintain and improve services despite the hugely challenging financial climate. However, they can only succeed if they work in partnership with others in a co-operative environment.'
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