East London doctors are accusing the government of planning to privatise the NHS after a leak from the Department of Health.
The draft document, entitled ‘Developing Commissioning Support: Towards Service Excellence’, lays out proposals for who will organise NHS care when the current system is replaced.
Under the plans the Governent has debated and made public, the role of commissioning (buying) care was to be put into the hands of groups of GPs called Clinical Commissioning Groups.
But the document seen by EastLondonLines suggests much commissioning power would actually pass to private companies.
It proposes that where CCGs are not deemed ready to commission, a national board should employ staff with top-down direction on their behalf until 2016. This support, it goes on, “would operate at arms length from the NHS… and operate on commercial lines”.
GPs claim its definition of ‘commissioning support’ includes almost everything the new health bill is supposed to put doctors in charge of.
The draft lists NHS functions from assessing patient needs and designing services to consultation, contract management, quality assurance and managing the press, which GPs say could go into private hands.
“Complex, large-scale contracts,” the document reads, should be managed above the level of CCGs. Only “third sector contracting, learning disability services and localised community services” should be procured locally.
The NHS sector, it concludes, “needs to make the transition from statutory function to freestanding enterprise”.
Hackney GP Jonathan Tomlinson, 39, sees this line as a smoking gun for the government’s desires.
The father of two, who who has worked at the Lawson Practice on Hackney’s Nuttall Street for 10 years, spoke to EastLondonLines about the reforms, which he believes are a roadmap to privatisation. He said: “There’s almost nothing left for us to do.”
He stressed that the document did not establish policy for certain, but said: “This is an as explicit a statement of intention to privatise the NHS as we’ve yet seen.”
Asked about the likely effects of reform, Tomlinson listed: “a lack of accountability, lack of GP control, and decisions being made by accountancy firms and health insurance companies rather than GPs,” as well as cuts to nurses and replacement of GPs by nurse practitioners.
His area, he says, is a particularly deprived and challenging one, where 50 per cent of people have long-term sickness, and where problems with the NHS will have a deeper effect than elsewhere.
Brian Fisher, a Lewisham GP who chairs the Socialist Health Association, told EastLondonLines the proposals were “complete insanity” and “no use to local communities at all,” claiming it contradicted Coalition promises that NHS reform would put doctors in charge.
He said: “It’s not surprising, but it does confirm all one’s worst fears, which is that they are very, very keen for commissioning to be done by private organizations.”
Lewisham health activist Jos Bell of SOS NHS accused the government of deliberately setting GPs up to fail to create opportunities for the private sector, adding “layer upon layer of unaccountable bureaucracy.”
She said: “After months of warnings about GPs lack of expertise in commissioning, and the challenges of managing costs, [Secretary of State for Health] Andrew Lansley is revealed as having all this time been working undercover against his own rhetoric.”
While the document does not name who will provide support, professionals fear that only international health companies will be big enough to handle the huge task of commissioning for the UK.
Tomlinson points to firms such as UnitedHealth, who in March sold their GP practices in the UK and announced that the future was in commissioning support.
United’s California subsidiary was fined $3.5m (£2.25m) in 2009 after the state insurance commissioner alleged 130,000 claims handling violations over a two year period. United won a contract to advise PCTs in July last year.
London CCG groups received £75,000 each in October to seek organisational training from firms including Capita and KPMG. Lansley accepted a £21,000 donation from the chairman of private provider Care UK while in opposition.
Companies like these, Tomlinson fears, could take control away from local areas. He said: “Decisions about where patients can get their care and what drugs they can be prescribed will be made further away than ever from their GP.”
Tomlinson said: “At the end of the day, I need to work in a functional system to look after my patients. What we stand to lose is the most equitable and efficient healthcare system in the world.”