By Gareth Iacobucci
Prime Minister David Cameron has dramatically removed the 2013 deadline for GP consortia to take over full commissioning responsibility, saying GPs should only assume full control when they are 'good and ready'.
In a keynote address to health professionals at University College London Hospital, Mr Cameron scrapped Andrew Lansley's April 2013 deadline for consortia to take on full commissioning responsibility.
In a speech the BMA said was a 'significant step in the right direction', Mr Cameron also pledged that other healthcare professionals would be involved in commissioning and that GPs will sit alongside nurses and consultants to review the integration of care in new 'clinical senates'.
The movement on the timetable for the transition comes after heavy pressure from Lib Dems to achieve concessions on the bill, with deputy prime minister Nick Clegg recently hinting strongly that the 2013 deadline for all GP consortia to assume control of NHS budgets was likely to be relaxed.
In a speech aimed at bolstering support for the coalition's under-fire NHS reforms, the Prime Minister set out his five key pledges on the NHS that he vowed to be 'personally accountable' on, following the conclusion of the Government's listening exercise last week.
His five pledges are:
- Not to endanger universal coverage - ensuring that it remains a NHS
- Not to break up or hinder efficient and integrated care, but to improve it
- Not to lose control of waiting times, ensuring they are kept low
- Not to cut spending on the NHS, but to increase it
- Not to sell-off the NHS but to ensure competition benefits patients.
He said: 'I've heard the concern that the direction is right but the pace is too fast. What if some places, some practices aren't ready?'
'We will make sure local commissioning only goes ahead when groups of GPs are good and ready, and we will give them the help they need to get there.'
He also laid out plans to have hospital doctors and nurses sitting on 'clinical senates' with GPs to support integration of care.
'We will not break up or hinder efficient and integrated care, we will improve it. And that means making changes to our current proposals.'
'Hospital doctors and nurses will be involved in clinical commissioning. We will also introduce clinical senates where groups of doctors and healthcare professionals come together to take an overview of the integration of care across a wide area.'
Mr Cameron also confirmed that health regulator Monitor will have a new duty to support the integration of care, and said its primary purpose would be to 'protect and promote the interests of people who use healthcare services'.
The Prime Minister said he was in favour of competition, but not as 'an end in itself', and insisted the plans were not ideologically led. Addressing fears that the reforms would lead to privatisation.
'This isn't some ideological theory. We will not be selling off the NHS or moving to an insurance scheme or moving towards an American private system'.
Despite the widespread opposition to the health bill, Mr Cameron said he felt many people were changing their view on the reforms following the Government's listening exercise, and insisted it was only the details of the reforms that were up for debate, not the fundamental principles behind it.
BMA chair Dr Hamish Meldrum said the speech was 'encouraging'.
'The Prime Minister's speech suggests he is committed to integrated NHS services, and the involvement of a wider range of staff in their design. However, he also spoke in glowing terms about the benefits of competition, and we would point to the many damaging effects its application in the NHS has had so far.'
'It is positive that he recognises the need for a level playing field, with private providers contributing to the costs of training, and unable to cherry-pick the most profitable services.'
'While we obviously await the details of the Future Forum report, and the amendments to the Bill, today's speech is an indication of a significant step in the right direction.'
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