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White paper consultation round-up

Consultation on the Government’s health white paper has now closed. Alisdair Stirling summarises the responses

Consultation on the Government's health white paper has now closed. Alisdair Stirling summarises the responses

Many of the key professional organisations that have responded to the Government's consultation on its proposed NHS reforms agree on three things: the scale of the reforms is unprecedented, their potential impact is incalculable and the pace of change is potentially too fast.

It's true that a lot has already changed in a very short time frame and it's worth recapping on the timescale so far.

The coalition government came to power less than six months ago on 11 May 2010 after a week of political horse-trading in the wake of the general election result of a hung parliament. The new coalition published its agreed policies – including those on health – on 20 May.

The health white paper Equity and Excellence: Liberating the NHS was published on 12 July, swiftly followed by four consultation documents on commissioning for patients, transparency and outcomes, local democratic legitimacy and regulating healthcare providers.

The intervening time has been filled with frenetic consultation, hasty surveys and urgently arranged workshops and meetings.

And having lit the blue touch paper on its white paper bombshell, the government has pressed on with a succession of health policy announcements without waiting for a reaction. Abolition of NHS Direct, a major cull of health quangos and suspending the review body pay process for doctors and dentists are chief among these.

Two further white paper consultations have since been opened on access to information and patient choice and control.

The consultation period on the four initial documents officially finished on 11 October and the ball has been bounced back into the government's court – for now. A health bill, which is likely to be ‘enabling' legislation rather than a detailed blueprint for change, is imminent and the government's official response to the consultation will come in December.

That is likely to signal the end of what GPC chair Dr Laurence Buckman has termed a ‘phoney war'. And as a look at the consultation responses of the major players reveals, some battles lie ahead.

But whether that will make any difference to the GP early adopters who are already voting with their feet remains to be seen. For the GP commissioning consortia that have already formed, the others already piloting real commissioning budgets and the significant numbers of others ready to assume shadow consortia earlier than April 2011, the changes can't come soon enough.



‘We welcome the direction of travel. Primary care has a pivotal role to play in this agenda through improving access to primary care services, improving the quality of those services by reducing unwarranted variation in clinical practice and more closely integrating primary care services with other providers, allowing safe transfer of services from an acute setting into the community.'

NHS Alliance

‘In some parts of the country GP consortia will be ready to assume responsibility for commissioning now and in the very near future (but) there are others who will require more development support and time. We believe there should be sufficient flexibility within the proposed timetable to accommodate everyone.'

NHS Confederation

‘Empowering patients is clearly the right thing to do, and there are strong arguments for involving clinicians closely in decisions about care and resources. But the reforms mean a major shift in culture and the way the NHS does business, as well as a shake-up of institutions. The government plans to build a very big new machine – at great pace – but no one can be quite sure what will happen when it is switched on.'

Nuffield Trust

‘Our analysis concludes that the government's proposed NHS reforms are broadly in the right direction and that they will be a success if they help the NHS to live within tighter resources while continuing to improve quality and health outcomes. However, the fast pace of reform carries significant risks – particularly given the constraint on resources.'

King's Fund

‘We support the need for reform but question the need to embark on a fundamental reorganisation of the NHS when evidence shows that health outcomes and public satisfaction have improved in recent years. The scale and speed of reform will distract attention from finding the efficiency savings needed to maintain quality and avoid cutting services.'


‘There are aspects of the white paper's proposals which have the potential to undermine the stability and long-term future of the NHS. We remain opposed to the active promotion of a market approach in the NHS and to the very significant threats to national conditions and terms of service and education and training for doctors contained in the white paper.'


‘The principles of greater GP leadership and influence are well received, but members have expressed concerns that the scale in which changes needed to be made is not justifiable – especially in the context of cost reductions – and there are concerns that the proposed scale, pace and cost of change will prove disruptive.'

Local Government Association

‘Councils need to be at the heart of commissioning, especially in the areas they have expertise. GPs are inexperienced here and there's a risk they may not see the incentive of commissioning services where success isn't easy to measure, or might outsource commissioning for these groups.'

Patients Association

‘This is a massive re-organisation of the NHS which could have a serious impact on staff and lead to instability. We have had lots of promises, but let us see if the rhetoric becomes the reality for patients – the proof will be in the pudding.'

Alisdair Stirling is a freelance journalist

Consultation round-up Consultation round-up Consultation responses Where the organisations stand

To view our table showing where the different organisations stand on the different strands of the white paper plans, please click here.

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