This site is intended for health professionals only

NHS reforms will drive a wedge between GPs and specialists

Competition drive will shatter collaborative ethos of NHS, says shadow health secretary John Healey.

What a difference a few months make.

When the Government published its plans for NHS reorganisation, they were met with cautious interest from doctors. Few could disagree with the stated aims of increasing patient choice and bringing doctors closer to commissioning.

I don't disagree with the aims – Labour supported them in power. But the more people look at the NHS changes, the less they like them. The more they analyse how the new system will work in practice, the more they realise that the aims will be overwhelmed by the Government's commitment to full-scale competition and a full-blown market in healthcare.

GPs are being presented with a false prospectus – the reforms no longer look like what doctors were promised. That is why we are seeing that over 60% of doctors are now against the reforms.

We support getting the wide range of clinicians more involved in commissioning. But the Government's proposals fail to harness the real benefits of greater clinical involvement and patient engagement. They are a huge upheaval at a time when the NHS is faced with tough financial pressures.

I see five flaws in the way that GP commissioning is being introduced.

Firstly, I can't see that it makes sense for commissioning to be solely the preserve of GPs, as it surely requires the involvement of a range of primary and secondary care clinicians. One of the main problems that the NHS has grappled with is the split between primary and secondary care, and this bill will only widen it. We want to bring clinicians together rather than create barriers to greater collaboration.

Second, I worry about what the reorganisation will do to the trust between a patient and their GP. GPs are their patients' expert advocate, but for the first time doctors will be making decisions on referral as well as rationing on an individual basis. They'll have one eye on their patient and the other on the consortium's bottom line. This concern has been raised forcefully by RCGP chair Dr Clare Gerada, who warned in November that ‘patients might think that the decision made about their healthcare will be based on self-interest – GPs saving money for themselves rather than spending it on patients'.

Third, for all the rhetoric of decentralisation, the reforms will actually leave commissioners with less autonomy to make the best decisions in their circumstances. GPs will find one hand tied by the NHS Commissioning Board and the other bound by Monitor, which can direct them to commission differently to promote competition.

Fourth, GP consortia will have very weak obligations on proper public openness, scrutiny and accountability. Many of the most important decisions will in future be stamped ‘commercial in confidence'.

Fifth, and most fundamental, is the introduction of full-blown competition, including competition on price. Every piece of research shows that price competition in healthcare forces down quality, encouraging profit over patient care.

The reforms will harm integration and collaboration as fragmentation and competition rules will push different elements of the system apart. We can see more and more clearly that the Tories' commitment to market competition comes first, and patient care second. And the powers of competition regulation will outweigh the forces of effective clinical leadership or patient engagement. GPs are not liberated, but subject to new restrictions which are fundamentally at odds with the founding ethos of the NHS.

If the Government's aim really was that commissioning be undertaken by clinicians and the public in partnership, then this could have been achieved without the upheaval that is being forced on the NHS. But the true purpose of the Conservative plans for the NHS are different – and lie not in what they are saying, but in what they are doing.

John Healey is shadow health secretary and Labour MP for Wentworth and Dearne.

John Healey - Shadow health secretary