By David Williams
16 November 2010
Health experts have questioned the evidence for the
government’s proposed restructure of the NHS, telling MPs that the reforms risk
fragmenting the service and entrenching inequalities.
A panel of leading health academics told the Commons health
select committee this morning that the coalition’s plans to put GP consortiums
in charge of commissioning services could disrupt the service at a time
unprecedented financial pressure.
Steve Harrison, professor of social policy at Manchester
University, questioned the ‘received wisdom’ that primary care trust managers were
not very effective.
‘There is not a lot of systemic research evidence for that –
it is not clear that is the case,’ he told MPs.
Jennie Popay, professor of public policy and social health
at Lancaster University’s Institute for Health Research, added that despite
individual examples of good practice, ‘at a system level the evidence is not
She argued that one consequence of the government’s
proposals could be that the most innovative and successful GP groups were those
with the least demanding populations. ‘There is a real risk that GP
commissioning will compound inequalities.’
She added that Health Secretary Andrew Lansley’s plans to
set up a National Commissioning Board to oversee GP consortiums appeared
‘un-thought-out’, as it risked introducing a new layer of complexity into the
Martin Roland, health services research professor at
Cambridge University, warned that prioritising competition between public and
private health providers could become a barrier to more integrated working.
He warned that if Monitor, which is to become the NHS’s
economic regulator, enforced new rules on competition too strictly it could
stop primary care doctors and acute-sector consultants collaborating, on
‘There is a real risk of fragmentation,’ he said. ‘It would
be an absolute disaster if that happens’.
The directors of two of the leading health think tanks also
questioned the plans. Jennifer Dixon, of the Nuffield Trust, said the reforms
were ‘too risky, too much, too soon’, and that the performance previous GP
commissioning initiatives suggest that it will be years for the consortiums to
Chris Ham, of the King’s Fund, said most of the improvements
brought about by GP commissioning in the past are in elective care, rather than
more complex emergency procedures which require a more strategic approach.
However, Julian Le Grand, professor of social policy at the
London School of Economics and former adviser on health to the previous Labour
government, broadly welcomed the reforms. He said they had been piloted over
the past 20 years’ experiments with GP fund-holding and practice-based
commissioning. But he admitted that evidence suggesting GP-led commissioning
worked better was mainly anecdotal.
Le Grand added that the reforms proposed by Lansley were closer to
what he and former Prime Minister Tony Blair wanted to do than the practice-based
commissioning option that was eventually implemented.
He also suggested that a ‘patient premium’, modelled on thecoalition’s pupil premium proposals, could be one way to direct more
resources to the poorest communities.