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Hopes and fears over NHS review

The face of surgeon Sir Ara Darzi is set to become increasingly familiar in the NHS over the next 12 months.

The face of surgeon Sir Ara Darzi is set to become increasingly familiar in the NHS over the next 12 months.

The world-renowned surgeon, turned Government adviser and part-time health minister, is spearheading a wide- ranging review that his boss, new health secretary Alan Johnson, describes as a 'once in a generation' operation.

Mr Johnson says doctors are 'fed up with too many top down instructions' and 'weary of restructuring', promising the next 10 years will be 'based less on central direction and more on patient control, choice and local accountability'. There will be an interim assessment of Sir Ara's report in the autumn, to inform the comprehensive spending review, although the full results will not be published for a year.

The Government promises to involve doctors, patients, nurses and other practitioners. But what could this review have in store for GPs, and will it signal the change in policy direction by the Department of Health that so many GPs are desperate for?

Some observers suggest the Government will put the brakes on private sector involvement in the NHS. Mr Johnson quickly signalled that controversial new independent sector treatment centres will only be given the go-ahead if they add capacity. GPs have welcomed this if it means alternative providers will only be used to plug gaps in existing services or challenge failing services, rather than 'competition for competition's sake'. Yet at the same time APMS schemes are pressing ahead across the country, with an increasing role for the private sector, putting the Government on a collision course with the BMA, which has voted to oppose the spread of APMS services.

Sir Ara is a key supporter of so-called polyclinics, which are central to the report out this week on the future of London healthcare, which he headed. Made up of eight to 10 practices, along with other services, polyclinics look set to swallow up many practices in the capital in the next decade and the same could follow elsewhere. The plan has been condemned as 'Soviet' by acting GPC chair Dr Laurence Buckman. And Dr Stewart Findlay, chair of Durham Dales PBC collaborative, warns of a 'complete catastrophe for the NHS' if practices are forced to merge.

Another issue is practice-based commissioning. Patricia Hewitt was busy reaffirming the Government's commitment to PBC shortly before her career as health secretary expired. Yet if the NHS review is to breathe new life into PBC, the new health minister better hurry up. Leading enthusiasts warn that unless urgent Government action is taken to persuade PCTs to get their act in order, the initiative will fail.

Dr Mike Dixon, chair of the NHS Alliance, warns PBC cannot balance the NHS books 'unless we get a move on with it'. Dr James Kingsland, chair of the National Association of Primary Care, describes it as the 'cornerstone of the reform agenda' and says PCT chief executives must be brought on board or else it will collapse.

Meanwhile, the Government is being accused of sitting on the results of its long-awaited Patient Experience Survey, which is widely believed to have found positive patient perceptions of GP services, so that it can add a twist of negative spin, or 'bury the good news' during the summer. Dr Niti Pall, a GP in Smethwick and chair of Sandwell PCT's professional executive committee, thinks the Government, despite talk of a fresh start with GPs, will use it as a stick to put pressure on GPs to work extended hours and get rid of the MPIG. 'In our practice we're not talking about if we open later, but how we do it,' she says.

Dr Peter Swinyard, secretary of the Small Practices Association, voices the fears of many when he says the review will focus on 'hospital, hospital, hospital' because of Sir Ara's secondary care background. 'He probably doesn't have a clue of what goes on in a consultation,' he says.But Gordon Brown clearly sees Sir Ara's vision as key to the NHS's future, which looks destined for yet more big changes.

What GP leaders say

'It's disappointing that the Government feels it needs to undertake a review when the problems of the NHS have been apparentfor many months.'

Dr Hamish Meldrum, BMA chair

'It will mean a vast cultural change, but until we havea real partnership between frontline clinicians and managers any changes are going to seem tokenistic.'

Dr Mike Dixon, chair of NHS Alliance

'We have got to have a more locally managed service, rather than justa mini Departmentof Health.'

Dr James Kingsland, chair of the National Association of Primary Care

'The one thing people do not want is more change.We should be making the things that we need work and getting rid of some of the targets that have distorted clinical priorities.'

Dr Stewart Findlay, PBC chair for Durham Dales

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