"This House believes that commissioners don't have the patient's best interest at heart" – this was the highly controversial theme of Pharma Times' annual Great Oxford Debate, held this year at the House of Lords.
The speakers supporting the motion generally reserved their attacks on what they saw as the impossible demands which the Health and Social Care Bill seeks to place on GPs in their new role as commissioners.
"I am a strong admirer of the work of GPs, but I don't believe that the invidious role they have been given can possibly put patients at the heart of the NHS," said Labour peer Lord Philip Hunt, a former Health Minister and ex-chief executive of the NHS Confederation.
"Rather, GPs are being set up as the fall guys to legitimise a reduction in what the NHS will offer to the patient in the future," he claimed, pointing to the concerns of Royal College of General Practitioners (RCGP) chair Dr Clare Gerada, who has warned that "making GPs the new rationers of NHS care could ruin the long-established bonds of trust between them and their patients."
The Bill has been ill thought through and is a PR and communications disaster, added Eric Low, chief executive of the patient group Myeloma UK. "It required the sensible input of the Future Forum to help the government understand that to transfer complete control of commissioning to GPs was ludicrous, given their lack of experience in high-level financial planning and commissioning for a wide range of often complex and specialised disease areas."
The majority of GPs do not even seem to want to be commissioners, and they will be torn between conforming to the demands placed on them by the Quality, Innovation, Productivity and Prevention (QIPP) agenda and the NHS reforms and putting patients at the heart of their decision-making, said Mr Low.
"Yet again they will be doing what the politicians tell them rather than acting in the best interests of their patients," he added.
Also speaking for the motion, commentator and broadcaster Roy Lilley told the audience: "we are witnessing history in the making - the denationalisation of the NHS."
'The Bill is designed to bring in the private sector - I have no problem with that," said Mr Lilley. But, he added: "commissioners will not be GPs - they will be the companies working for GPs."
'In an NHS that has funding flat-lining, rising demand and the tariff squeezing the pips, it is an inescapable truth that commissioners don't have the patient's best interest at heart because they cannot," he said.
Opposing the motion, Conservative MP and NHS hospital doctor Daniel Poulter defended the Bill. It will, he said, ensure that that the NHS always remains a universal free service and provide the first-ever steps towards creating an integrated care service, which will save money and be better for patients.
Good commissioning is about putting doctors and other health care professionals in charge, working with managers, and its role is to empower health care professionals and set them free to respond to local healthcare priorities, added Dr Poulter, who is MP for Central Suffolk.
"Can we believe that commissioners might have malevolent intent? Are they doing it for the money, status or job security?"" asked NHS Confederation chief executive Mike Farrar, also opposing the motion.
They are not, he said. "People do commissioning to try to coordinate care, get the best returns and do the best for their patients," said Mr Farrar. "Commissioning is an attempt to balance the needs of the patient in front of the doctor with those who are not and also with the public interest," he said, adding: "this is a very strong public good."
And, he asked, what would happen without commissioning? "Providers do not always have to provide optimum care, and with commissioning the public would be left in a very exposed position," he warned.
Mac McKeever, former NHS trust chief executive, agreed. "Commissioners work with the very best of intentions," he said, and described that the criticisms raised by the motion as "unfounded and unfair."
The audience obviously agreed - the motion was defeated in a 50-25 vote, with one abstention.
* Thanks to all the sponsors of this year's Great Oxford Debate at the House of Lords - Alchemist, Dispensing Doctors Association, Quintiles and Zenopa.