The BMA says that positive elements of the government's plans for the NHS in England - such as devolving more control to patients and frontline clinicians, and a stronger focus on public health - are at risk from other aspects that seek to accelerate a market-based approach.

In its response to the 'Equity and Excellence: Liberating the NHS' White Paper, the BMA says it is interested in exploring proposals for most services to be commissioned by consortia led by GPs. It believes that successful commissioning can only be achieved if other clinicians, such as hospital consultants, are also brought into the process, and if there is meaningful engagement with the public and patients. It also says consortia must have sufficient management and administrative support to take on the additional responsibilities.

The BMA also warns that proposals that would encourage further competition in the NHS - such as extending choice to "any willing provider" and giving the foundation trust regulator Monitor a duty to promote competition - would risk shifting the focus onto cost rather than quality, and would undermine opportunities to work more collaboratively across primary and secondary care.

Dr Hamish Meldrum, Chairman of Council at the BMA, says: "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 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. Doctors want to build on the founding principles of the NHS, and to maintain and improve services despite the hugely challenging financial climate. However, they can only succeed if they can work in partnership with others in a co-operative environment."

The BMA's response also says that the current climate - in which the NHS is already being forced to make cuts - is a very challenging one in which to make substantial service changes. It questions whether the aims of reducing bureaucracy and empowering clinicians could have been achieved through less disruptive structural change.

The BMA response also:

- says protection of national terms and conditions is essential to ensure an equitable spread of staff across the UK

- supports the reduction in top-down NHS targets, but calls for greater clinical input into the proposed new outcomes framework

- expresses serious concerns about the determination for all trusts to have foundation status by 2013-14

- questions whether there is any evidence that significant numbers of staff wish to work in social enterprises, and urges caution in changing the ethos of NHS provision

- expresses support for the elimination of unnecessary bureaucracy but says it would be wasteful to delegate inappropriate management tasks to clinicians

- insists on a national approach to education and training

Note

Registered BMA media centre users can view the full BMA response and an additional briefing paper here.

Source:
British Medical Association