By Ellie Broughton
The RCGP has written to the Prime Minister David Cameron calling for a raft of changes to the health bill and warning that the Government's plans could open the door to consortia charging for NHS services.
In a wide-ranging analysis of the NHS reforms published today, the college said it had 'serious concerns' about the move to cost competition in the NHS and urged the PM to consider amending the role of Monitor so that the body promotes cooperation between services rather than competition. Click here to read the full document.
The RCGP paper warned: 'The fear is that it will no longer be possible to deliver integrated services in practice, especially where integration relies on close collaboration between different providers and commissioners, and could be seen as anti-competitive.'
The college also called for plans to remove practice boundaries to be revised, said GP consortia should include places for 'a range of locally determined clinical, health and social care practitioners' and demanded that consortia should not be able to charge patients for healthcare services 'that are currently provided free by the NHS or are recommended by NICE'.
'As we understand it, the Secretary of State's duty to provide free services that are "part of the health service in England", except where charges are expressly allowed, is undermined by the proposed legislation,' the paper said.
'This is because the power under the Health and Medicines Act 1988 to impose charges is transferred from the Secretary of State to consortia (clause 22). Consortia will determine which services are part of the health service and, by inference, those that are not – and thus may be chargeable (clause 9). In addition they have been given a general power to charge (Section 7, 2h, Health and Medicines Act 1988).'
Dr Clare Gerada said the report set out a 'comprehensive analysis' of how the health bill can be changed and was backed up by evidence.
'We understand that the NHS needs to change, and we have said all along that the college is not opposed to health service reform,' she said.
'The reforms promote competition without sufficient clarification of how services to patients will be safeguarded and improved. We believe that provider side reforms could deal with many of the issues without the need for repeated organisational change or many of the proposed reforms.'
•Comprehensive healthcare: ‘The Bill should make it clear that the Secretary of State has a duty to provide, or secure provision, of a comprehensive health service throughout England.'
•Charging for healthcare: ‘Commissioners or providers should not be able charge patients for health care services that are currently provided free by the NHS or are recommended by NICE.'
•Market forces in healthcare: ‘The Bill should place a duty on Monitor, the National Commissioning Board and GP Commissioning Consortia (GPCC) to enable collaboration to provide integrated services to meet patients needs without fear of a competition referral.'
•EU competition: ‘There needs to be clarity as to the legal implications of EU competition law (particularly when, and in what circumstances, it is enforceable) and other contractual and regulatory details.'
•Accountability and conflicts of interest: ‘Consortia must remain publicly accountable for all commissioning decisions, so that Board minutes and financial decisions are open to public scrutiny, including details of payments made to GPs or Practices for non-general medical services, including payments to private companies in which GPs have a financial interest.
•Resource allocation and risk pooling: ‘That there is clarity as soon as possible as to which allocation formula will be used for allocation to GP consortia for commissioning hospital care.'
•Practice boundaries: ‘The proposal to undermine the relationship between a local GP and local patients by abolishing practice boundaries is revised.
•Workforce and training: ‘Given that the education and training proposals mark a revolution in medical education and could be harmful in primary care, we urge a careful and detailed reconsideration ahead of any implementation.'
•Confidentiality: ‘That there is as an absolute assurance that the Bill will not force doctors to breach their duty of confidentiality.'