BMA: more risks than pros in white paper

The BMA has criticised the government’s plans to overhaul the NHS in England, saying they contain “much that would be potentially damaging” to the health service.

In its response to ‘Equity and Excellence: Liberating the NHS’, the doctors’ trade union says positive aspects of the white paper have to be weighed against potential risks.

The 34 page document identifies devolving control to clinicians and patients and putting more emphasis on public health as positives. But it says these are put at risk by "aspects that seek to accelerate a market-based approach."

The response to the Department of Health’s three month consultation on the implementation of the white paper also gives the BMA’s verdict on specific plans, such as access to records, online consultations, and Choose and Book.

Dr Hamish Meldrum, chair of BMA Council, said: “There are proposals in the white paper that doctors can support and want to work with. But there is also much that would be potentially damaging.”

The white paper will trigger another major reorganisation of the NHS. It plans to scrap strategic health authorities and primary care trusts, and set up GP commissioning consortia to control 80% of the NHS budget.

The BMA says it is “interested in exploring proposals” for GP commissioning but is "extremely alarmed at the potential vacuum and loss of skilled staff that could occur."

It says both types of organisation should be retained until consortia are fully operational. And it calls for more details about where the non-commissioning functions of PCTs will lie.

The response points out that PCTs have many responsibilities that will still need to be undertaken after they are abolished, including the allocation of practice IT funding, emergency planning, and the administration of GP appraisals.

The BMA also questions whether the cost of reorganising the health service will deliver value for money when the NHS needs to release £15-20 billion of efficiency savings over four years.

And it says plans to encourage further competition in the NHS, such as extending choice to ‘any willing provider’, risk shifting the focus onto cost rather than quality.

Dr Meldrum added: “The BMA has consistently argued that clinicians should have more autonomy to shape services for their patients, but pitting them against each other in a market-based system creates waste, bureaucracy and inefficiency.”

The white paper outlines plans for an NHS "information revolution", including publication of more NHS data, access to records for patients, and more use of online communications.

The BMA says online services offer new opportunities for the public and patients to access information and communicate with their healthcare professionals. However, it also says they pose significant risks.

For example, while the BMA sees value in online services for administrative functions – such as repeat prescription ordering – it sees risks in online consultations, including risks to confidentiality, the potential for misdiagnosis and potential delays in communication.

The document adds: “We therefore believe that online communication needs further piloting and should be introduced on a voluntary basis before being implemented more widely.”

The BMA’s response states that the association also has concerns about the government’s plans to publish more data online.

It argues this could be misinterpreted, and says it will oppose any moves to link patient surveys or feedback to GP practice funding.

It says the white paper’s proposals to give patients easier access to their records “should be considered as a long-term strategic aim.”

The consultation document also argues against proposals to encourage more NHS providers to become social enterprises.

The association asks whether there is nay evidence that significant numbers of staff want to work in social enterprises and argues that any moves in this direction could lead to a two tier workforce, with new entrants not having access to the NHS pension.

On patient choice and Choose and Book, the BMA says it supports the government’s plans to list named consultants for elective care but claims it would not be appropriate for all services. The BMA is also opposed to mandatory use of Choose and Book.

The government’s consultation on the NHS white paper closes on 11 October.