News review 2012: Health and Social Care Act

Andrew Lansley pushed his NHS reforms through parliament in 2012, then was shown the door. But despite opposition, the changes are going ahead.

National Health Action Party plans to field candidates in 50 constituencies at next election.
National Health Action Party plans to field candidates in 50 constituencies at next election.

NHS reforms set in motion by the then health secretary Andrew Lansley reached a landmark stage as 2012 drew to a close, with a first wave of CCGs formally authorised to take over from PCTs.

A total of 34 groups have been approved, albeit with caveats, with the rest of the 211 across England due to be rubber-stamped by early March.

Supporters believe that where previous rounds of NHS reform failed because primary care clinicians were excluded, this time could be different. CCG successes have seen GPs play a key part in work including redesigning services to cut referrals, reduce unplanned hospital admissions and improve long-term care, often saving huge sums in NHS funding.
But opposition to the reforms did not stop when the Health and Social Care Act received royal assent in March.

Opposing health reforms
Last month, health professionals including south London GP Dr Louise Irvine formed a political party to oppose the health reforms and the commercialisation of the NHS.

The National Health Action Party plans to field candidates in around 50 constituencies at the next general election.
The BMA remains opposed to the reforms, but was recently forced back to the drawing board on its plans to take action. Lawyers warned that GPs could face legal action if the BMA gave them ‘pledge cards’ inviting patients to opt out of the right to be referred to private providers.

The early months of 2012 saw other high-profile efforts to force a rethink on NHS reform. Manchester GP Dr Kailash Chand, now deputy chairman of the BMA, secured more than 170,000 signatures on an e-petition opposing the reforms, finally forcing a debate in the House of Commons in March.

As peers in the House of Lords prepared to discuss the reforms, the RCGP made its position crystal clear. A poll released in February found 98% of its members opposed the changes.

Chairwoman Professor Clare Gerada said: ‘When we look back in years to come, I want there to be no misunderstanding of the position the college has taken.’

This sort of vocal dissent may well have played a part in the government’s decision to move the then health secretary Andrew Lansley in September to make way for Jeremy Hunt, seen as a better communicator.

Unlike his predecessor, Mr Hunt has yet to inspire a rap, or be chased around a hospital by Medical Practitioners Union president Dr Ron Singer, a prominent critic of the reforms.

Despite some successes, the NHS Commissioning Board (NHSCB) faces a tough task to oversee the final stages of scrapping PCTs and getting CCGs up and running.

Risk register
Back in March, a leaked draft of the risk register Mr Lansley fought to keep behind closed doors revealed fears over CCGs going bust, concerns about managing the GP contract and GP leaders not being developed enough.

The NHSCB will need to decide exactly what the controversial ‘quality premium’ successful CCGs may receive can be used for. Doubts remain about ‘constitutions’ that CCGs are expecting GP practices to sign up to – earlier this year the BMA warned practices not to sign draconian agreements that could force them to hit tough referral or financial targets.
Despite strong and vocal opposition, the health reforms survived 2012, even if their principal champion did not. In 2013 the real moment of truth comes – how will they turn out in practice?

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