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Trusts risk wrath of Lansley as they ignore GP opposition to hospital closures

By Ian Quinn

NHS managers are ploughing ahead with plans for massive cutbacks to services in the face of GP opposition - despite health secretary Andrew Lansley's claim that GPs should have the final say over any major service reconfiguration.

The BMA, the NAPC and the Family Doctor Association have all told Pulse that trusts in different parts of England have been forging ahead with proposals, including the closure of hospital A&E departments, maternity units and children's services, against the wishes of the local GPs.

In Kent, the Maidstone division of the BMA today called for the immediate intervention of the health secretary, claiming he was being made to 'look stupid' by local NHS managers. Maidstone and Tunbridge Wells NHS Trust, backed by NHS West Kent, is pressing ahead with plans to close the maternity and paediatric services at Maidstone hospital, and to transfer them next summer to a new PFI hospital in Pembury.

Yet a survey of local GPs shows overwhelming opposition to the plans. With responses from 90 out of 127 local GPs, 91% were in favour of keeping maternity services at Maidstone and 91% against the transfer of children's services.

Dr Paul Hobday, a GP in Maidstone and LMC representative, said: ‘The trust is pushing ahead as fast as it can with these plans and is completely flying in the face of Andrew Lansley's ruling. If he allows this to go through then he will be made to look stupid. He will have fallen at the first hurdle because our survey shows GPs are overwhelmingly opposed to what's going on.'

The GPs' intervention in Kent comes on the same day as the BBC revealed the NHS in England faces a massive £65 billion bill for new hospitals built under the controversial PFI initiative, with trusts left with annual repayments accounting for more than 10% of their turnover.

In a recent letter to all trusts, NHS chief executive Sir David Nicholson made it clear all service reconfigurations must have 'support from GP commissioners'.

He added that 'where local commissioners are unable to provide evidence' that GPs support their plans, SHAs should 'consider halting the proposal'.

Yet accusations of trusts pushing ahead with reconfigurations against GPs' wishes are growing.

In the capital a string of trusts in northeast London are pushing ahead with plans to close the A&E unit at King George Hospital in Ilford, claiming that the majority of the workload can be switched to polyclinics, despite a string of LMCs expressing their outrage at the plans.

A spokesman for Health for North East London said trusts were ‘finalising the programme's next steps'.

Dr Peter Swinyard, chair of the Family Doctor Association, said there was growing anecdotal evidence from GPs that trusts were ignoring Mr Lansley's ruling and pushing ahead with plans, including the closure of hospital services and plans to shut down small GP practices.

He said: ‘I am expecting Andrew Lansley to stamp on this pretty swiftly because he has made it clear that it is GPs who should have the final say on service reconfigurations and commissioning of services.'

‘When the night of the long knives comes and PCTs are abolished, the good PCT managers will find themselves a home in GP consortiums. Those who have behaved irresponsibly and ignored the wishes of GPs will find themselves down at the dole queue with no future ahead of them.'

NAPC president Dr James Kingsland said it would be ‘a disaster' if PCTs were allowed to forge ahead with service re-designs against the wishes of local GPs.

A DH spokesperson said Mr Lansley had backed an earlier call from the Independent Reconfiguration Panel for Kent County Council's Health Overview and Scrutiny Committee to carry out a local investigation into the potential impact of the changes, which is expected to run until September.

She said: 'In addition the Secretary of State for Health since setting down further criteria for reconfiguration has asked the local NHS to engage with clinicians, local authorities, local GPs and patient groups to consider.'

A spokesperson for NHS West and Maidstone and Tunbridge Wells NHS Trust said: 'We are continuing to work hard to involve GPs in this process. We have written to GPs inviting them to take part in one-to-one interviews and focus groups as well as a GP event in September so that we can capture their concerns and suggestions and work together to reflect these views in the implementation of our plans.'

But she added: 'The changes are based on sound clinical evidence. '

Dr Peter Swinyard: NHS managers who ignore GPs will find themselves on the dole queue Dr Peter Swinyard: NHS managers who ignore GPs will find themselves on the dole queue