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Letter of the week: The concerns Lansley must address to sell reforms

Open letter to health secretary Andrew Lansley

I have been a GP for 33 years and have lived and worked through numerous reorganisations – each stimulated by new governments or health ministers, many of whom are not around long enough to see the consequences of their actions. As an experienced GP and patient, I am most concerned about the proposed upheaval to the health service for the following reasons:

• Loss of trained personnel This reorganisation will result in the loss of many trained managers plus frontline GPs, and replacements will have to be trained and then moved into back offices to plan services.

• Wasted resources By scrapping the current system and starting again, we are once again throwing away money. We had fundholding under the last Conservative government, then Labour brought in primary care groups, only for them to be abandoned and replaced by PCTs.

• No long-term planning Once again, the NHS is going to be reorganised without any pilot testing on a significant scale. The NHS has been in the control of short-term politicians, resulting in a lack of cohesive long-term planning.

• Variation in care I have always been a staunch advocate of GPs having a real say in the running of the NHS. The closest we came was with fundholding, but even that system was unfair to patients – because it depended on how effective individual GPs were in securing care. Herein lies the next problem. Which GPs are going to be given control of these new budgets? Are these going to be the favoured few who sit in ivory towers, who may not see a patient for weeks? The GPs doing the work, who understand fully the problems, will be too busy caring for patients.

• Destruction of the NHS There will be fragmentation, decentralisation and privatisation of the health service, which will create an unprecedented postcode lottery for patients. With the loss of national planning and organisation, we will increasingly have locally implemented systems of care, which are not effective.

I therefore ask you to address the following:

• How can the NHS become national once again? What planning will be put in place to ensure equitable and effective care across the country?

• How will the GPs holding the budgets be selected?

• Who will be accountable for the inevitable waste of resources, both physical and in personnel, as a result of this reorganisation?

• What clinical outcomes will be used to judge the effectiveness of this new huge upheaval in care?

From Dr Mark Levy,
Brent and Harrow

Dr Mark Levy