The new Health Secretary Andrew Lansley has announced a radical reform plan for the NHS which has shocked some commentators. In the first of a series of articles about the proposals, Health Editor Barry Nelson sounds out the views of a cross-section of North-East academics.

THE last Government introduced many innovations during its 13 years in power and each change was usually piloted by a small group of pioneers.

But that is not the policy adopted by the new Health Secretary Andrew Lansley, who has gone for a Big Bang approach.

Loading article content

He plans to demolish the present structure of 152 primary care trusts (PCTs) and ten strategic health authorities and replace it with up to 500 groups of GPs – or consortia – which will manage the NHS’s £70bn budget.

The coalition Government believes these changes will improve the delivery of health care, reduce management costs and save the NHS a fortune.

Professor David Hunter, who holds a chair in health policy and management at Durham University, is amazed at the sheer scale of the proposed changes.

“There will be no experiments, no pilots, just the whole NHS system put into freefall,” says Prof Hunter. He fears the reforms could seriously damage the NHS as we know it and describes the approach as “a scorched earth policy”.

Despite Mr Lansley serving as shadow health secretary for more than six years, Prof Hunter has the distinct impression that the plans are the result of some back-of-the-envelope thinking.

“You do get that impression because, at the moment, it doesn’t really add up,” he says.

The health service analyst is worried that handing over funding for the NHS to groups of GPs could lead to variations in health care delivery on the ground. “We already know GP engagement in commissioning healthcare it is very patchy. It is going to be very uneven,” he says.

While there will be a few who will be enthusiasts and who might deliver improved services, for the most part Prof Hunter believes most GPs do not really want this and have not got the skills to do it. “There is also the risk that the best GPs will end up spending most of their time on commissioning,” he adds.

He also fears that setting up 500 GP consortia, “with at least half a dozen people managing the back office functions in every group”, will end up costing the NHS a lot of money.

With thousands of jobs expected to be lost when primary care trusts are abolished in 2013, Prof Hunter wonders how many managers who possess valuable commissioning skills will end up being expensively paid off and then re-employed by the NHS. “Will these managers go directly into the consortia from the PCT or SHA (Strategic Health Authority), or will they be paid off by the NHS, nip off to the private sector and then sell their skills back to the Health Service?” he says.

Prof Hunter also wonders whether Mr Lansley has a hidden agenda to break the back of the public sector and open up the market to private health care. “There are a lot of big American and European companies who are sniffing around and are incredibly enthusiastic about what is happening.”

WITH the present structure of the NHS “flattened”, Prof Hunter fears that an already disadvantaged North-East could suffer a reduction in the quality of services, leaving aside the issue of many NHS jobs disappearing.

“The worry is the issue of inequality. GPs tend to be least effective in the poorer areas.

You will have the successful GPs being even more successful and the unsuccessful ones just being left by the wayside.”

Managers in the NHS are left feeling “like being on the bridge of the Titanic” and Prof Hunter believes many must be considering jumping ship before the PCTs and SHAs sink beneath them. He fears the new health team in Whitehall could be making a huge mistake.

“Everybody’s health is at stake and the whole basis of the NHS could be undermined,” he says.

“We could end up with a shell organisation with the NHS brand and nothing behind it.”

Prof Hunter says the current situation – with much of the NHS in limbo – is creating huge uncertainty, which is “highly dangerous”.

His concerns are shared by Professor Alan Maynard, who holds a chair in health economics at Nottingham University. He sums up the gung-ho approach adopted by Mr Lansley as like “jumping off a cliff” into the unknown.

Prof Maynard also describes the reforms as “the kind of major re-disintergration we go through regularly”.

“When something like this was tried in the Nineties by the Conservatives it was voluntary, but this new approach is compulsory. It seems to be aimed at turning the GPs into gamekeepers in the hope they control the hospital consultant poachers,” he says.

Prof Maynard jokingly compared the Government’s approach to Soviet-style “forcible collectivisation”. While it was “very bold”, he warns that the high-speed reforms being pushed through without any attempt to evaluate their success involved “potential risks”

for the NHS.

BUT some academics believe Andrew Landsley deserves some congratulation for his vision.

Professor Greg Rubin, who holds the chair of general practice and primary care at Durham University, says: “I do think it is positive and I think it is putting GPs and clinicians more directly in charge of delivering NHS services. I think it will give us a less bureaucratic service, allowing us to be a bit more fleet of foot.”

He forecasts that putting GPs in charge of NHS budgets will speed up the implementation of new services. “Things will flow more quickly.

GPs are used to making decisions more quickly,” he says. “Until now, we have been frustrated by the structures of the NHS. I think there will be much better communication between doctors in primary care and doctors in secondary care.” He stresses that the expertise of many of the current PCT managers will need to be harnessed by GPs.

Prof Rubin admits there are “a lot of risks”

but in principle he believes that the general thrust of the Government’s health reforms are “very positive”.

“The biggest worry is the transitional period,”

he says. “The big challenge will be to bring about an orderly transition from where we are now to where we want to be.”

But that is not the policy adopted by the new Health Secretary Andrew Lansley, who has gone for a Big Bang approach.

He plans to demolish the present structure of 152 primary care trusts (PCTs) and ten strategic health authorities and replace it with up to 500 groups of GPs – or consortia – which will manage the NHS’s £70bn budget.

The coalition Government believes these changes will improve the delivery of health care, reduce management costs and save the NHS a fortune.

Professor David Hunter, who holds a chair in health policy and management at Durham University, is amazed at the sheer scale of the proposed changes.

“There will be no experiments, no pilots, just the whole NHS system put into freefall,” says Prof Hunter. He fears the reforms could seriously damage the NHS as we know it and describes the approach as “a scorched earth policy”.

Despite Mr Lansley serving as shadow health secretary for more than six years, Prof Hunter has the distinct impression that the plans are the result of some back-of-the-envelope thinking.

“You do get that impression because, at the moment, it doesn’t really add up,” he says.

The health service analyst is worried that handing over funding for the NHS to groups of GPs could lead to variations in health care delivery on the ground. “We already know GP engagement in commissioning healthcare it is very patchy. It is going to be very uneven,” he says.

While there will be a few who will be enthusiasts and who might deliver improved services, for the most part Prof Hunter believes most GPs do not really want this and have not got the skills to do it. “There is also the risk that the best GPs will end up spending most of their time on commissioning,” he adds.

He also fears that setting up 500 GP consortia, “with at least half a dozen people managing the back office functions in every group”, will end up costing the NHS a lot of money.

With thousands of jobs expected to be lost when primary care trusts are abolished in 2013, Prof Hunter wonders how many managers who possess valuable commissioning skills will end up being expensively paid off and then re-employed by the NHS. “Will these managers go directly into the consortia from the PCT or SHA (Strategic Health Authority), or will they be paid off by the NHS, nip off to the private sector and then sell their skills back to the Health Service?” he says.

Prof Hunter also wonders whether Mr Lansley has a hidden agenda to break the back of the public sector and open up the market to private health care. “There are a lot of big American and European companies who are sniffing around and are incredibly enthusiastic about what is happening.”

WITH the present structure of the NHS “flattened”, Prof Hunter fears that an already disadvantaged North-East could suffer a reduction in the quality of services, leaving aside the issue of many NHS jobs disappearing.

“The worry is the issue of inequality. GPs tend to be least effective in the poorer areas.

You will have the successful GPs being even more successful and the unsuccessful ones just being left by the wayside.”

Managers in the NHS are left feeling “like being on the bridge of the Titanic” and Prof Hunter believes many must be considering jumping ship before the PCTs and SHAs sink beneath them. He fears the new health team in Whitehall could be making a huge mistake.

“Everybody’s health is at stake and the whole basis of the NHS could be undermined,” he says.

“We could end up with a shell organisation with the NHS brand and nothing behind it.”

Prof Hunter says the current situation – with much of the NHS in limbo – is creating huge uncertainty, which is “highly dangerous”.

His concerns are shared by Professor Alan Maynard, who holds a chair in health economics at Nottingham University. He sums up the gung-ho approach adopted by Mr Lansley as like “jumping off a cliff” into the unknown.

Prof Maynard also describes the reforms as “the kind of major re-disintergration we go through regularly”.

“When something like this was tried in the Nineties by the Conservatives it was voluntary, but this new approach is compulsory. It seems to be aimed at turning the GPs into gamekeepers in the hope they control the hospital consultant poachers,” he says.

Prof Maynard jokingly compared the Government’s approach to Soviet-style “forcible collectivisation”. While it was “very bold”, he warns that the high-speed reforms being pushed through without any attempt to evaluate their success involved “potential risks”

for the NHS.

BUT some academics believe Andrew Landsley deserves some congratulation for his vision.

Professor Greg Rubin, who holds the chair of general practice and primary care at Durham University, says: “I do think it is positive and I think it is putting GPs and clinicians more directly in charge of delivering NHS services. I think it will give us a less bureaucratic service, allowing us to be a bit more fleet of foot.”

He forecasts that putting GPs in charge of NHS budgets will speed up the implementation of new services. “Things will flow more quickly.

GPs are used to making decisions more quickly,” he says. “Until now, we have been frustrated by the structures of the NHS. I think there will be much better communication between doctors in primary care and doctors in secondary care.” He stresses that the expertise of many of the current PCT managers will need to be harnessed by GPs.

Prof Rubin admits there are “a lot of risks”

but in principle he believes that the general thrust of the Government’s health reforms are “very positive”.

“The biggest worry is the transitional period,”

he says. “The big challenge will be to bring about an orderly transition from where we are now to where we want to be.”