Editorial: Burden of bureaucracy could end GP support

In years to come, the Health Bill will be held up as an example of how not to create policy.

Everything has been done back to front. The consultation happened halfway through the reforms, instead of at the start, and now a series of late changes may well undermine any positive progress that has been made.

Some of the amendments the government proposes are welcome, such as the removal of Monitor's power to promote competition and safeguards against price competition. But the changes to 'clinical' commissioning create a complicated mess, through which GP commissioners will have to navigate.

As GP reveals this week, many consortia (or 'clinical commissioning groups', as they must now be known) have already taken responsibility for millions of pounds of NHS funding and begun commissioning services.

But now health and well-being boards and clinical senates - which do not even exist yet - will not only have a say in local commissioning plans, but will also decide whether consortia can continue in their current form. Consortia that cross local authority boundaries may struggle to justify their existence.

Health secretary Andrew Lansley last week claimed there was nothing to stop GP commissioners pressing ahead. But there are many questions that consortia will want answered, not least how much freedom they will really have now three different bodies have the power to veto - or at least object to - the decisions they make.

The changes will do little to encourage more GPs to take on a commissioning role and there is a danger that in some areas clinical commissioning could founder.

And what of the cost? The new boards and senates must have huge financial implications at a time when money is tight.

It is ironic that this Bill, which set out to deliver local control to GPs and make the NHS simpler, could make things even more complicated. Many GPs have embraced commissioning, but the government will surely lose their support and enthusiasm if the new layer of bureaucracy it proposes becomes too burdensome.

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