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Independents' Day

This back-door reorganisation spells the end of NHS general practice

Dr Kailash Chand

Dr Kailash Chand

Today sees a second legal challenge to the introduction of accountable care organisations (ACOs) debated in the High Court. Campaigners, previously backed by the late Professor Stephen Hawking, argue ACOs will ‘Americanise’ the NHS, bringing in a two-tier insurance based system like US Medicare, with limits on what is provided for free.

ACOs are based on informal arrangements with no basis in law, yet are being lined up to be given extensive authority including, potentially, power over combined budgets for an area worth billions of pounds.

NHS England argues ACOs are about integrating health services to make the NHS sustainable. The truth is that ACOs are being established to cut services and allow private companies to receive and benefit from significant sums of tax-payer money. The Government plans to spend billions awarding giant contracts for at least 10 years to private for-profit providers. It will confuse the public and profession by calling these ‘integrated care services’. The reality is that the commercial contracting involved will be used to transfer statutory decision making for planning and resource allocation to non-statutory bodies. In this way, the risks and costs of care are shifted to patients.

Coincidently, the Labour party is today bringing a motion for debate in the House of Commons, demanding the Government releases all plans related to privatisation, outsourcing, wholly owned subsidiaries and ACOs. The Government, led by Jeremy Hunt, will no doubt dismiss this as ‘scaremongering’.

The Government wants to avoid another reorganisation catastrophe

Meanwhile the BBC has reported that the Government is considering scrapping some of the controversial NHS reforms introduced by former health secretary Andrew Lansley in England in 2012. This meaningless ‘top-down re-organisation’ was the biggest health policy disaster since the inception of the NHS in 1948. It was a criminal waste of money, costing over £4 billion, and so destructive to the NHS that it would be hard for those of us who campaigned against it all along to take any comfort from being proved right. In any case, we must be sceptical about the Government’s motivations here. Many of the organisations founded through the 2012 Act, including CCGs, were established on a statutory basis. Legislation is needed for ACOs to replace organisations such as CCGs.The Government wants to avoid another reorganisation catastrophe, so it intends to bring in mergers of CCGs to align with ACOs without legislation – and CCGs will no longer be necessary once ACOs are in place.

We must be clear about the danger this restructuring poses for general practice. Moving to a fully integrated ACO means saying goodbye to the current model of general practice, and the end of the independent contractor status for GPs. It means that GPs will no longer be independent advocates for their patients and local communities. Simon Stevens, the NHS England chief executive, when first starting in his role, gave a clear message that CCG mergers were not part of his plan. He said he did not want NHS managers consumed by thoughts of organisational restructuring and their own positions. Yet now this is happening at an unstoppable pace. GPs and social services, already grossly overstretched, will be expected to do more. We are heading for the complete demise of all NHS standards. This is really the beginning of the end of the NHS, and the start of a third-world standard health system. But maybe that is the plan. I am no fan of CCGs but I now fear their abolition. In my view CCGs are the last vestiges of local accountability to local people, and port of call to local GPs.

It appears another reorganisation in disguise is inevitable. The rapid change in health economies, such as devolution in Manchester, and development of integrated care and ACOs is happening fast. My fear is this experiment too could end in tears like Lansley’s act. And in the process traditional general practice, and with it universal health care, will end for good.

Dr Kailash Chand is a retired GP from Tameside


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Readers' comments (12)

  • I think you are incorrect when you say that ACOs are the death of general practice. My understanding is that we are funded by GMS which is laid down by statute and cannot easily be changed. We GPs need to stick to our main job which is providing in hours medical care. Making us responsible for hospital costs, community costs and emergency OOH costs is all too much for an overstretched GP service. CCGs are a disaster because they make us responsible for the lack of NHS funding. I for one would be very happy to move to ACOs and no longer be held responsible for inadequate funding elsewhere. Just doing my own job well is challenge enough....

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  • It transpires from the article and the first comment that we are kept in the dark regarding our future. Conspiracy theories abound with CCG colleagues telling me that CCG are here to stay and will become more autonomous, Local authority friends that soon the CCGs will be under the aegis of the local councils, hospital colleagues that CCGs will disappear "in five months" and so and so on. If the BMA, the LMCs and the RCGP are not prepared to throw some light, then PULSE under its new editor might consider a special investigation on the future of general practice and the CCGs.

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  • I'm confused.
    I think I will just muddle on until able to retire

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  • Merlin
    Wisest words on the internet this week!!!

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  • Thats all most of us are doing,thanks god Im in the 1995 pension scheme!Who will look after us when we retire though.

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  • not accountable,
    don't care,
    not organised.
    ACO is a lie boldly stated.
    Accountability requires transparency and openness.

    Caring is expensive and we have and efficient system which has been driven to destruction.

    Taking funds out for increased 'administration' and 'share holders' reduces cost efficiency.

    This arrangement in rail has been shown to be a poor deal for the people, and for taxpayers. The disorganization of rail franchises clearly demonstrates the failure of this model. Strangely they involve the same companies too!

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  • Yes, ACOs/ICSs will indeed mean the end of general practice as we know it.

    Despite promises of up to five (actually three) 'options' for alignment of GP contract with ACOs, in truth there is only one pathway/mechanism for this arrangement.

    ACOs must - and will - eventually take over GP lists, thereby dissolving the GMS contract, forever.

    General Practice is intended to become an outreach arm of secondary care.

    A set of "informal arrangements" we are told by NHSE. Yes, let's informally dismantle the NHS, but pretend that everything good about it will stay the same.

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  • @Nick Mann SPOT ON !

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  • When the nhs is properly resourced every system will work fine and general practice is a great career. When the nhs is badly under resourced every system will fail and high quality general practice is undeliverable

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  • My understanding is nobody can force us into an ACO, and devil will be in detail of the deal e.g. return ticket, which you won't find here....

    Unless the GPs in Manchester and Dudley are from a different GP tribe, (those who HAVE looked at the detail), there might be a sensible way to engage here...

    More detail on reality please Pulse, not inane 'end is nigh' merchants

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