Exclusive: 'I want no part of NHS privatisation', says NHS chief

In an exclusive interview Sir David Nicholson allays GPs' fears over NHS reform.

Sir David Nicholson: 'Any willing provider is a rather unfortunate term. It's not "any" and it's not "any willing"' (Photograph: JH Lancy)
Sir David Nicholson: 'Any willing provider is a rather unfortunate term. It's not "any" and it's not "any willing"' (Photograph: JH Lancy)

'I wouldn't want to be part of something that privatises the NHS. I'm an NHS person and have been throughout the 30 years of my working life.'

So says NHS chief executive Sir David Nicholson, when asked whether privatisation is the motive behind the government's NHS reforms.

With Nottingham Forest FC mug in hand, he adds: 'What it does do is open up doors that haven't been opened up before.'

In his first primary care press interview since his appointment as NHS Commissioning Board chief executive, he adds: 'There are services we provide that aren't good enough and if we have the opportunity for change we should make that happen.'

GP consortia
The NHS Commissioning Board will be responsible for the GP consortia that will contain all of England's GPs from April 2013 and oversee £80 billion annually, the bulk of the NHS budget.

So what is Sir David's message to GPs?

'This is a clinically-led organisation which is there to support and help consortia be the best they can possibly be. We don't want to catch them out.'

Collaboration is a key theme of this 30-minute interview and Sir David is keen to stress the importance he places on building relationships with bodies including the GPC.

Last month he wrote to pathfinders and NHS staff explaining that tariff flexibility shouldn't lead to price competition.

Does he think the Health Bill should be amended to make this clearer?

'That's a matter for politicians,' he answers. But he stresses that quality, not price, is key for the NHS.

He refuses to rule out the possibility that the GPC's wish for consortia to be able to draw up lists of preferred providers might be granted.

'Any willing provider is a rather unfortunate term. It's not "any" and it's not "any willing" because we are talking about public money to treat NHS patients and providers would have to be registered and licensed.

'They'd have to persuade commissioners that they could provide quality services.'

Consortia and the GPC should be involved in designing the process to ensure this happens, he adds. 'It's in no-one's interests for providers simply not able to deliver quality being involved.'

We touch on DoH policy to abolish practice boundaries, which many GPs fear is a reform too far given the Health Bill's emphasis on commissioning.

Sir David emphasises the real need to work with GP consortia and is determined to forge collaborative links with the GPC (Photograph: JH Lancy)

Practice boundaries
Last week, GP reported a suggestion by the Conservative Medical Society that consortia should be able to refuse to treat patients with no link to a local area once practice boundaries are removed.

Sir David will say only: 'There are detailed discussions at the moment and it's quite difficult for me to comment on it.'

Some GPs have criticised plans to allow the Board power to decide whether consortia accountable officers are 'appropriate' and when they should leave.

But Sir David emphasises the importance of working with consortia over appointments ('we would want to be satisfied that consortia supported the individual') plus the need for training and education.

Answering RCGP criticism that GPs will have little time for service redesign as savings are sought, Sir David counters: 'That's one of the reasons why there will be £2 per head to help them backfill.'

When asked whether the Board will have a regional presence in the same way that there are strategic health authorities now, Sir David says: 'This is not like the NHS used to be.'

He mentions the need for management tiers; for Board/consortia relationships on a number of different issues including finance allocation, accountable officer approval, designing the commissioning outcomes framework and how the quality premium works.

Sir David admits to being 'surprised' by the speed of his appointment, which wasn't expected until much later this year.

It inevitably offers the coalition government a continuity at the top of the NHS it may well come to prize in the coming months of Health Bill debate.

Reassurance on NHS reform
  • Sir David says 'new doors are being opened up', but there are no plans to privatise the NHS.
  • The NHS Commissioning Board will be supportive and clinically-led.
  • Quality, not price will remain paramount in delivery of NHS services.
  • 'Any willing provider' policy is a misnomer - providers will be registered and licensed and must meet NHS standards.

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