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GP commissioning leaders claim Lansley has ‘lost the narrative’ as support for health bill splinters

By Gareth Iacobucci | 07 Feb 2012

Exclusive: The deepening controversy over the Government's NHS reforms is driving a wedge between GP commissioning leaders, with some calling for the health bill to be abandoned and one leading adviser admitting it could ‘fail' even at this late stage.

Health secretary Andrew Lansley has endured a tumultuous week, with the RCGP formally calling for the bill to be withdrawn and support beginning to splinter even among leading champions of commissioning.

RCGP chair Dr Clare Gerada  became the first leader of a medical college to call for the bill to be scrapped. She had been granted a deferred mandate from the college's council to opt for outright opposition to the bill  should she judge the amendments to it to be insufficient.

Dr Gerada said the bill would cause ‘irreparable damage' to the NHS, and added: ‘[We have] been left with no alternative.'

The NHS Alliance, an enthusiastic supporter of clinical commissioning, is split on whether the bill should be withdrawn. Its chair Dr Michael Dixon insisted the legislation must be passed to give sovereignty to GP commissioners and said amendments tabled last week – which included making it clear the health secretary and CCGs would be responsible for maintaining a ‘comprehensive national health service' – eased many concerns.

But other senior figures at the NHS Alliance disagreed, including Dr David Jenner, Dr Dixon's practice colleague in Cullompton, Devon, and lead for Eastern Devon clinical commissioning group. Dr Jenner signed a letter to the Telegraph along with 293 fellow GPs – including three other commissioning leads – calling for the bill to be withdrawn as it threatened to ‘fragment the NHS into a collection of competing private providers'.

Fellow NHS Alliance member Dr Brian Fisher also signed the letter, while Dr Ron Singer, a retired GP and founding member, wrote on Twitter: ‘Mike Dixon hopelessly clings to GPs winning out versus private-sector giants. Alliance split over this. It represents naïve GPs.'

Dr Isabel Hodkinson, co-vice chair of Tower Hamlets CCG, was one of those to sign the letter, and said: ‘Initially I was enthusiastic, but as I've seen how it's gone I've realised it's just not going to work. I'm really unhappy about moving commissioning support from the NHS.'

It came as Dr James Kingsland, a GP in Wallasey, Merseyside, and the national clinical lead for the NHS clinical commissioning community, admitted at a conference last week that ministers had ‘lost the narrative' on the NHS reforms.

Dr Kingsland, who is also president of the National Association of Primary Care, said the debate over the reforms had ‘stagnated', and there was now a risk the health bill would not become law: ‘We have lost the narrative of the reforms and there is a short time until the Queen's Speech – if we don't make it, the bill will fail. We have to just get the law in place – forget about whether it is right or wrong.'

Dr Charles Alessi, NAPC chair, said: ‘It would be a great pity if the bill doesn't go through because clearly anything that helps clinical commissioning is something we support.'

But a fellow GP close to Mr Lansley, who wished to remain anonymous, said the health secretary had failed to get his message across: ‘Once you alienate the professions, you alienate the public. The narrative, and some great opportunities for reform, have been lost.'

READERS' COMMENTS

Gary Young, Practice Manager,
07 Feb 2012
- We have to just get the law in place, forget about whether it is right or wrong - PARDON ME, this is our National Health Service we're talking about here..! Another article today suggests Lansley has lost the support of all the major medical colleges - frankly this rotten bill should never of had their support, nor tacit support of BMA. Kill the bill and then ASK those in NHS how they think it could be run better rather than dupe the voting public and those who work in NHS with pre-election promises of no reorganisation and no cuts then, 8-weeks later, impose 20% efficiency savings and savage the NHS organisational structure.
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John M. Orchard, GP Partner,
07 Feb 2012
I despair, Why give Dr Gerada a licence to continue her maverick politically motivated assaults on the government. Did anyone really think PCTs worked at all. Arrogant ,unapproachable management heavy monoliths who ignored GPs and prevented meaningful discussion between primary and secondary care.
We CCGs are opening channels of communications shut down by the micro management obsessed Labour party. I am enjoying practice for the first time since 1999 ( when PCGs vanished)
The RCGP should encouraging quality practice and give up political posturing.
Dr John Orchard FRCGP
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Simon Ruffle, GP Partner,
07 Feb 2012
If the government and PCTs had protected and funded genral practitioners properly, to be in management with them, PCTs would have worked better. I for one was prescribing lead and PEC member for 4 years until the worload of my PCT responsibility outweighed the pay and back up support I could give to my practice. CCGs will find out the same painful way. As far as I'm concerned we can find no back up for my partner who is away at a CCG meeting again, muggins here and collegues will be backing up for him. It already is impacting what is delivered! Practitioners who go into management totally loose touch, which is why it is vital to provide proper support to doctors and their collegues to continue the front line work but can contribute to improving the health service, without stuffing their own patients and partners with a poorer experience.
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Anonymous, PCT,
07 Feb 2012
John

Enjoy the freedom while it last. The real problem is that nothing is changing at the top. Same people, same methods, same control. Sure the organisations names are changing but the Bill still leaves all the power with the NCB not with CCG's.
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Anonymous, PCT,
07 Feb 2012
Dr Kingsland's CCG won't be given authorisation by the NCB as it doesn't meet the criteria laid down by the DoH. Will he still be happy to "just get the law in place - right or wrong" then?
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Nancy Blake, Other healthcare professional,
28 Feb 2012
The word 'MAINTAIN' is not the same as the word 'PROVIDE'. The heart of the 'reform' is getting rid of the legal mandate for the government to 'PROVIDE' a comprehensive health service. The bill then creates an overall commissioning board which will be legally obliged to encourage competition and to award business to the 'most cost effective' aka 'cheapest' provider. These will be the big U.S. medical insurers/providers, who will be able to undercut any local bids.
The legal mandate for the NHS is to provide health care. The legal mandate for any private company is to act in the financial interests of the shareholders.
Whatever Cameron may claim his intentions to be, the outcome will be an outflow of UK taxpayers money, intended for health care, into the pockets of U.S. investors. Whatever the other 1500 pages of the 'reform' bill contain, removal of the government's obligation to 'PROVIDE' a health service spells the end of the NHS.
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