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Andy Jones: Reform, or White Paper is worthless

There has been a lot of talk recently of the White Paper. We have seen headlines responding to supposed patient demand, the 'health MOT' being the most notable.

There has been a lot of talk recently of the White Paper. We have seen headlines responding to supposed patient demand, the 'health MOT' being the most notable.

And without a doubt some interesting stuff is up for discussion. First, a clear attempt is planned to improve health care and spending in under-resourced and deprived areas. Second, an attempt will be made to produce some joined-up thinking between health and social care. Third, we will see local diagnostic services and minor procedures implemented using the revolutionary idea of a community hospital.

But the big question is, has one of the Government's biggest-spending departments acquired sufficient appetite for reform? For this is what we need to see in the NHS. The current Government has been in power since 1998 and will have trebled health spending by 2008. Yet so far there has been little in the way of a real shake-up. And only a real shake-up will stop the health service tumbling around our ears.

Take practice-based commissioning. This could be considered a necessary evil or a brilliant opportunity, depending on your point of view. But whatever you call it, it would be far more effective if primary legislation was passed to allow GPs to hold actual budgets and not mysterious indicative budgets. This way true savings could be retained by practices and spent locally by GPs, to maximum effect.

There is no incentive in the current system. Savings will be wasted paying back deficits in amalgamated PCTs and meeting commitments to growth. Most enthusiasts for practice-based commissioning will be lucky just to stand still.

Again, patient choice has been much trumpeted. But choice means little in financial or reform terms if patients make decisions with their doctor about secondary care without any consideration of cost. Similarly, in primary care, 70 per cent of practice costs are fixed and unaltered by patients moving practices.Money must start to follow patients in a competitive market.

But without a significant change in contracts and funding, the opportunities for expansion and innovation across the whole country will be greatly limited. Commissioning and provision must remain separate for all this to work.

Unless we look together at value for money, the wheels are going to fall off the NHS after the 2008 spending cycle. The White Paper's attempts at social care integration and so on should be applauded. But they lack ambition. They need to be bolder.As I said at the start, we need to see a real spirit of reform.

Dr Andy Jones is a GP in Stamford, Lincolnshire

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