Editorial: GPs need detail on any changes to Health Bill

Before this year's LMCs conference even started, the profession seemed to win some concessions from the government on its Health Bill.

Perhaps anticipating the mauling his government's proposals would receive, prime minister David Cameron announced a series of changes two days before the conference began (ahead of the publication of his much-vaunted listening exercise).

Monitor will now be duty-bound to support service integration, although it will still promote competition, the 2013 deadline for the creation of consortia has been scrapped and other professional groups will be involved in commissioning.

Despite Mr Cameron's attempt to head off criticism, anti-Health Bill sentiment among delegates was rife and there was scepticism about whether his changes did enough to prevent the threat of privatisation. The message was clear: GPs will not stand for any reform that damages the health service or doctors' relationships with their patients.

However, the conference also highlighted that tension among the profession concerning GP commissioning remains. Some fear it will make GPs the rationers of care, irrevocably damaging the GP/patient relationship; others passionately believe GPs can make a better fist of things than managers when it comes to prioritising care, and commissioning enables them to deliver real improvements for patients.

It is not the headline-grabbing changes to the Bill that will resolve these tensions and ensure GPs feel confident taking responsibility for the NHS budget in England - it will be in the detail of how the reforms translate into real life practice.

For example, will consortia receive a quality premium, despite fears it creates 'perverse incentives', and what role will the NHS Commissioning Board actually have?

If Mr Cameron and health secretary Andrew Lansley are to convince GPs their plans will improve the NHS and can work in the real world, they must address the profession's concerns as they set out the detail of how the Bill would be implemented.

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