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Leading academics say NHS market reforms ‘will block integrated care’

By Ian Quinn

A report by leading academics claims the Government's market-based reforms will lead to huge conflict of interest among GPs and prevent them from working closely with specialists to improve services.

A paper in the New England Journal of Medicine, co-written by Professor Martin Roland, the author of the QOF, attacks the Government's plans to ramp up competition, saying they will lead to fragmented care and make it harder for GPs to work in an integrated way with NHS hospital clinicians.

The report describes the reforms as high-risk gamble which could lead to many years of disruption to services.

Professor Roland, professor of health services research at the University of Cambridge and his co-author, Dr Rebecca Rosen, a GP and senior fellow in health policy at The Nuffield Trust, says the ‘immense' changes far outstrip plans for market forces to be unleashed in the NHS envisaged even under the Thatcher Government.

The report claims the 'GP bonus' system likely to be introduced by consortia to reward practices which remain under budget risks leading to mass conflict of interest.

Professor Roland told Pulse: 'The mechanism by which consortia will control budgets is unclear. But there will be downward pressure on costs meaning there will be considerable pressure on GPs not to refer, and this of course represents a grave conflict of interest. Giving quality premiums also presents a conflict of interest.

'The second concern is around any willing provider,' added Professor Roland. 'The requirement may actually prevent GPs from selectively talking to one provider, and if that prevents conversations with local consultants about patient care that could be detrimental. It's actually happened in the Netherlands, which also has market-based elements, where Dutch GPs are prevented from having these conversations because of competition regulations.'

The paper attacks the 'striking absence' of thought about integrating patients care in the bill, which it says contrasts starkly with the most successful health organisations in the United States.

'The separation of papers and providers will make it harder for GP commissioners and specialist physicians to align their goals.

'Indeed there is concerns the regulations being established to promote competition will actively prevent GP commissioner groups from developing close alliances with local specialists.'

The report says it will be at least three years before any benefits will be felt from the health bill by which time the authors predict the Government will have lost patience and embarked on yet another restructure.

'Major health services reforms cause years of disruption and English health care will go through a process of disorganisation for three of four years before benefits can be expected from this new round of changes,' it says.

'Experience suggests that governments do not have the patience to see major changes through, especially when general elections loom.'

Leading academics say NHS market reforms 'will block integrated care'