The impact of the NHS Reforms, Health and Social Care Bill on the healthcare industry: part 2

Part 2: Opposition and opportunities

Opportunities with GP consortia - Helping GPs run consortia

The British Medical Association (BMA) welcomes greater clinician control, but has concerns about the burden of responsibility on GPs. In a recent BMA members feedback survey, they found that 80% of just under 1000 of their members were ‘mostly unwelcoming’ or ‘very unwelcoming’ of the bill.

One concern is that the money from the new NHS Commissioning board will be provided to GP consortia based on successful outcomes, not volume, hence competition will be a new factor for GPs to contend with . The GPs have voiced concerns over their lack of skills for running the consortias. As a result, there is an opportunity for companies to build new relationships by offering training and management services to help GPs. Companies that manage this will undoubtedly have an impact on the shape of the new commissioning process.

The structure of GP consortia groups is as yet unclear, but there are now 141 pilot GP pathfinder groups set up to try out the function of the future GP consortias . At present GP pathfinder groups are collections of GP practices with staff coming from existing Practice Based Commissioning Groups (PBC). The GP pathfinder groups are currently taking project management advice from staff at existing PCTs, but others are signing agreements with private service and management companies.

The BMA have recently stipulated consent for disclosure on confidential patient information should be articulated clearly in the new bill . However the government insists that the Data Protection Act 1998 will ensure a continued patient consent requirement. Patient consent has been an issue for the NHS in the past, because anonymised data used for NHS research was in the form of individual patient numbers and not all the NHS IT systems could configure them. (See our news article on the “Trials and tribulations of the implementation of electronic patient records in England”).

New healthcare IT needs

The raft of changes to the NHS and wealth spring of new organisations will need new IT, accounting and patient management systems. In a recent article on the issue, John Gobron, director of Microsoft Health Solutions, indicated that GPs use outdated technology and that the volume of data required to run these new consortias will need to be streamlined. The opportunities for healthcare technology management systems and the firms that provide them are therefore vast.

Successful opposition from the Royal College of Nursing

The Royal College of Nursing (RCN) views the bill and the NHS savings of £20bn up to 2014 as a ‘cut too far and too fast’ into NHS functions. Like the BMA, the RCN is concerned that competition focus will adversely impact the quality of care. The RCN’s most recent response to the ‘listening’ exercise indicates that the nursing role in the proposed GP consortia should be enshrined in law. Indeed they wish the name ‘GP Consortia’ to be changed to ‘Clinical Commissioning Consortia’, to reflect the multi-disciplinary nature of healthcare provision and consortia membership .

In response to these concerns the Prime Minister said in a recent speech that GP consortias (commissioning consortiums, clinical consortias) would most likely now include nurses and hospital doctors to better represent care across the NHS. He also said ‘clinical senates’ would be set up to produce integrated care pathways across regional areas.

In direct response to the RCN’s concerns about the focus on competition, the Prime Minister states that Monitor will not only be an economic regulator but will also be tasked with ensuring that promotion of competition is actually translated into improved services and treatments for patients. David Cameron also explains that the focus is to create ability for the best providers to shine. He has strongly denied that the NHS will become an insurance-based healthcare system like in the US and that the NHS will continue to remain free at the point of use.

The RCN have also pointed out that the infrastructure for the new NHS system needs to be clearly planned out to prevent disarray in services and that the extent of decentralisation may result in a loss of a tactical oversight by one central body . Peer at the House of Lords, Lord Owen, echoes this sentiment and has concerns that the NHS, which already has many quangos, will become full of numerous unaccountable quangos. He urges healthcare staff to consider how they feel about the public holding them, not politicians, directly accountable for future failures in the NHS, because the bill will pass powers from the secretary of state on to them. Lord Owen also considers the policy of allowing ‘any willing provider’ (now termed ‘any qualified provider’) to submit services to the NHS as open to encroachment of EU laws relating to competition and procurement policy.