NHS reforms radical

The NHS in England is about to undergo radical change with the aim of saving more than �10 billion over the next 10 years.1

All 152 of the primary care trusts in England will be abolished.* Instead, from 2013, general practitioners (GPs) will be responsible for buying the care for their patients, a process which will be overseen by an NHS commissioning board. GP consortiums, which will control about 80% of the NHS budget, will buy services from various providers (public, private or charities). Medical professionals are critical of the changes, and the Royal College of General Practitioners says it is concerned about how the proposals will be implemented. The speed and the scale of the reforms has also been questioned.

However, the Health and Social Care Bill has the backing of MPs who voted 321 to 235 in support of the legislation at a second reading in the House of Commons on 1 February 2011.2

Why the rush?

Fiona Godlee, editor of the BMJ comments on the NHS reforms in an Editor's Choice article.3 She says that opinions on the reforms "have come thick and fast" since publication of the bill on 19 January 2011.

While some ideas within the bill are good, it is generally felt that the "reforms could destabilise the NHS and damage patient care", she says.

"So why now?", she asks. The government says it is to save money - but the changes will cost money initially and may not save any long term, according to some. Another justification for the reforms is that the government claims that the UK has poorer health outcomes than other industrialised countries such as France. However, chief economist at the King's Fund, John Appleby, says that these claims are misleading.

"Given the uncertainty, the risk, and the consensus of concern, the government would be foolish to press ahead. Let's see whether GPs already involved in practice based commissioning deliver, before rolling out such untested changes across the NHS", says Godlee.

* The reforms will result in a loss of 24 000 management jobs.

[Reference]

1. Ramesh R.NHS reforms: government unveils radical pro-market shakeup. Internet Document: [2 pages], 19 Jan 2011. Available from: URL: http://www.guardian.co.uk. .

2. McKee S.MPs vote in favour of Health Bill. Internet Document: [2 pages], 1 Feb 2011. Available from: URL: http://www.pharmatimes.com. .

3. Godlee F.NHS reforms - why now? BMJ: [3 pages], 26 Jan 2011. Available from: URL: http://dx.doi.org/10.1136/bmj.d552. .