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Government must clear fog over NHS reforms

The 'natural pause' is rapidly turning into a damaging hiatus. It has become clear over the past week that what had been intended as a six-week listening exercise on the health bill could stretch out over six months or more, as elements are sent back to the Commons to be debated afresh.


Few would argue over the need to substantially revise the bill, and the pause in proceedings was necessary. But it has been a chaotic process, in which alongside the formal consultation, the coalition partners have fought openly over the soul of the NHS.

Meanwhile, GPs on the ground and their commissioning leaders have been trapped in a strange limbo, still carried along by the early momentum behind the development of pathfinders and downgrading of PCTs, but unsure exactly where they will be carried to.

The confusion at the top of Government over how the reforms will develop is mirrored in every area of the country. PCT leaders describe the ‘utter shambles' of trying to allocate budgets for a future that is wholly uncertain, and GP consortium chairs warn the freeze in proceedings is stunting their development and hindering attempts to get a grip on the £20bn NHS efficiency challenge.

GPs who might have been hoping for clarity on the details of how commissioning will work, including how much they will have to get involved, what resources they will receive for the work and whether payments will be tied to restrictions in their referrals, have been disappointed as the debate has instead raged over the high-level politics of Monitor and the NHS market.

Health secretary Andrew Lansley has provided a case study in how not to implement a major public-service reform. His health white paper initially attracted considerable support among GPs, for its vision, however vague, of an NHS where clinicians were in the driving seat.

But Mr Lansley's failure to fill in the blanks, his determination to leave almost everything to be locally determined and his dogmatic trust in an open NHS market eroded that support. It was then that he made his most damaging error, in pressing ahead with the rollout of pathfinders, and publishing the health bill, before he had secured the support of the profession or the solid backing of his coalition partners. It was that misjudgment that has left GPs so trapped in uncertainty, forced to prepare for major change without knowing what that change will be.

It is too late to undo the stumbling progress of the NHS reforms, and ditching the central concept of GP commissioning would, as RCGP chair Dr Clare Gerada argues, throw the baby out with the bathwater. But the Government needs to provide clarity for GPs now, by either finalising those parts of the bill affecting development of consortia, or extending the reforms' timetable and providing guidance on how to organise the NHS in the interim.

And among the chorus of voices it must hear the core concerns of GPs, protect them from being financially compromised in their clinical decisions, and free them from the requirement to open up the market where that runs against their judgment as commissioners.

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