BMA: 'Bill must be changed significantly, if not withdrawn'

Britain's doctors are calling for the government's plans for the NHS to either be withdrawn or changed substantially.

This month, the British Medical Association (BMA) has been asking its members what they think of the Health and Social Care Bill. Nearly 1000 doctors replied and four out of five of them said said their attitude to the reforms was either 'mostly' or 'very unwelcoming'. The biggest concern was the plan for an NHS economic regulator Monitor to promote competition - over half of members identified this idea as 'potentially the most damaging'.

In its formal submission to the NHS Future Forum, the body leading the government’s listening exercise on the reforms, the BMA says the legislation represents 'an enormous risk' during a time of huge financial pressure for the NHS. It sets out its own recommendations for changes to encourage the development of more integrated services, arguing that greater collaboration would be more likely to improve quality and efficiency than the current proposals to increase and enforce competition. It is also concerned about the speed of the process and the Secretary of State for Health's plan to enhance his own powers.

The BMA submission calls for 'a more mature form of commissioning', based on clinical networks of specialists and primary care professionals working together across traditional boundaries, alongside commissioning consortia. The BMA is also today publishing new guidance putting forward examples of possible models for the governance of consortia and advising that, as a minimum, specialists should be involved in the design of patient pathways.

Collaboration not competition

The key recommendations in the BMA’s response to the Future Forum are that:

• The primary role of the economic regulator, Monitor, should be amended to protecting and promoting high quality, comprehensive, integrated services, not promoting competition
• There should be an explicit duty on commissioning consortia to fully involve all relevant clinical staff in commissioning
• National and regional oversight of doctors’ education and training should be maintained, with UK-level workforce planning, and regional quality management continuing to be undertaken by deaneries (the BMA today also publishes a letter to the Future Forum from its Junior Doctors Committee)
• There should not be an artificially rigid timetable for all NHS trusts to achieve foundation status, as the current deadline of April 2014 could compromise patient safety.
• The Secretary of State’s duty to secure the provision of comprehensive healthcare services for the people of England should be reinstated. Meanwhile his or her powers over the NHS Commissioning Board on appointments, further regulations and its mandate should be subject to explicit safeguards and transparency requirements to avoid unnecessary political interference
• The NHS Commissioning Board should be required to consult with consortia, where changes affect them, before making use of its powers to ensure an appropriate level of freedom
• The independence of directors of public health should be explicitly protected by bringing together all public health staff under a single NHS agency
• Patient consent should continue to be required for disclosure of confidential patient information

Dr Hamish Meldrum, Chairman of Council at the BMA, said: 'The message from doctors is clear and simple – the Bill must be changed significantly, if not withdrawn altogether, if the NHS is to continue to improve.

'We are right in the thick of the challenges the NHS faces, and while change is necessary, this major upheaval is not. We know that the NHS has to become more efficient, that chronic illness is growing, and that we need a step change in improvements in public health. Increasing and enforcing competition is not the answer – competition is not an end in itself. Instead, we are putting forward recommendations that aim to maximise the potential for positive change in the proposals, by genuinely giving more say to patients and to clinicians at the front line.'

• View the full BMA submission to the NHS Future Forum.