The vast majority of doctors are not convinced that potential benefits of the government's plans for the NHS in England outweigh the risks, an online survey for the BMA suggests today (Thursday 3 March 2011). An Ipsos MORI survey of BMA members, carried out in January this year, reveals a range of views, but widespread concern about plans to increase competition, even among the minority of doctors who are generally supportive of the changes.

The statements garnering the highest levels of agreement among the 1,645 respondents are: Increased competition in the NHS will lead to a fragmentation of services (89% agree) Increased competition in the NHS will reduce the quality of patient care (65% agree) The move for all NHS providers to become, or be part of, foundation trusts will damage NHS values (66% agree) The proposed system of clinician-led commissioning will increase health inequalities (66% agree) Overall, the survey suggests that doctors believe the changes that are most likely to be achieved are those which are least welcome. For example, almost nine in ten (88%) think it is likely that the reforms will lead to increased competition between providers, but only a fifth (21%) believe this will improve the overall quality of NHS care. Conversely, doctors believe the changes that would be most beneficial are least likely to be achieved. For example, two thirds (67%) think closer working between general practice and hospitals would improve the overall quality of patient care, but only a third (34%) believe it likely that the reforms will lead to this.

In terms of the impact on their own roles, three fifths of respondents (61%) think it likely that the reforms will lead to them spending less time with patients, a change which only 1% would welcome.

The survey suggests that doctors fall into three distinct groups according to their views on their personal role in relation to the proposed reforms. A third (33%) are broadly opposed, around a fifth (18%) are broadly supportive, and just over a third (36%) say they are waiting to see what happens. The scale and strength of concern varies significantly across the three groups, but even within the 'pro-reforms' group (those who say they want to help lead the changes or are keen to get involved) two thirds (67%) agree that increased competition in the NHS will lead to a fragmentation of services. And, while generally most positive about the proposed system of GP-led commissioning, a fifth of this group (22%) still think it will reduce the quality of patient care.

Dr Hamish Meldrum, Chairman of Council at the BMA, says: "This survey shows that the government can no longer claim widespread support among doctors as justification for these flawed policies. While there are widely differing opinions, with many still to decide, there are a number of key issues where the majority have very clear concerns. The government simply cannot afford to dismiss this strength of feeling amongst the group they are expecting to lead much of the change. Doctors overwhelmingly want there to be closer working between primary and secondary care, and to have greater involvement in decision-making - yet most think these are the least likely outcomes of the reforms. And nine out of ten doctors agree that increased competition in the NHS will lead to a fragmentation of services."

There are mixed views about the impact of the proposed system of GP-led commissioning. Two thirds (66%) agree it will increase health inequalities and half (49%) that it will reduce the quality of patient care. The vast majority (84%) of GPs have taken, or their practices have taken, at least one step to prepare for the reforms, for example, attending a meeting about clinician-led commissioning. But only half of GPs (49%) agree that GPs in their local area will be ready to take on new roles leading commissioning.

Dr Meldrum adds: "The Secretary of State has repeatedly said he wants to listen to doctors. Doctors are telling him that whole rafts of these proposals will either not achieve the intended benefit to patients, or will be harmful. He particularly needs to act on the concerns about competition."

Notes

1) View the full findings at bma//healthcare_policy/nhs_white_paper/moripoll2011.jsp

2) Ipsos MORI invited 18,456 BMA members in England (doctors in all branches of practice - GPs, consultants, junior doctors and Staff and Associate Specialist doctors, medical academics, public health doctors, and consultants) to complete an online survey between 17 and 28 January 2011. It received 1,645 responses - a response rate of 9%. The data was weighted to match the profile of BMA membership.

3) The government outlined its proposals for reform of the NHS in England in its White Paper Equity and Excellence: Liberating the NHS in July 2010. The Health and Social Care Bill was published in January 2011, setting out the legislation required to implement the reforms. The Bill is currently going through its House of Commons committee stage. The BMA is providing an online toolkit to support doctors in expressing their views to their MP

4) Doctors will discuss the reforms at a BMA Special Representatives Meeting on 15 March 2011.

Source
British Medical Association