The Health and Social Care Bill has taken somewhat of a beating in the last few days with a steady flow of criticism from the BMA.

The British Medical Association has this week accused the government of reneging on its promise put doctors "in the driving seat" for commissioning care, following its warning over the bill's potential threat to patient confidentiality.

The crux of the government's healthcare reforms is centred around handing over much of the NHS budget - around £80 billion of it - to GP-led commissioning consortia to allow frontllne clinicians to deliver healthcare that is better suited to local needs.

Much has been made of this radical, and still somewhat controversial, shift in the purchasing landscape, but according to a new BMA briefing paper on commissioning, the powers of the Secretary of State and the NHS Commissioning Board will be overly restrictive and controlling, despite government pledges to devolve power.

The Association says it is particularly concerned that the NHS Commissioning Board will not be free from political meddling, that it can dismiss and replace a consortium's accountable officer and even dissolve or change consortia areas without consultation. It also objects to the Secretary of State being able to impose any conditions on consortia without review.

“We are very concerned about how restrictive the Bill is and want to see that, at the very least, there is a duty to consult consortia written into the legislation," said Laurence Buckman, Chairman of the BMA’s GPs Committee. "At the moment the Secretary of State and the NHS Commissioning Board are being granted powers that are far too wide-ranging and seem to go against the promise to devolve power to local clinicians," he argues.

Publication of the briefing paper comes hot on the heels of a BMA warning last week that the confidentiality of patient records could be under threat under the new health bill.

It claims that the bill proposes that a number of bodies – including the Secretary of State for Health, NHS Commissioning Board and NHS Information Centre – are given righs to obtain and disclose confidential patient information for any number of unspecified purposes. 

“There is very little reference to rules on patient confidentiality that would ensure patients are asked before their information is shared or guarantee that the patient’s identity will not be revealed," said Vivienne Nathanson, Head of Science and Ethics at the BMA. 

“By failing to put in place proper safeguards, the government is potentially removing the control doctors and, most importantly, patients have over their confidential data," she noted, arguing that this goes against government promises to give patients better control over their medical care records. 

Nicholson comments

Elsewhere, National Health Service leader David Nicholson - and soon to be chief executive of the NHS commissioning board -  warned that the NHS is facing its "toughest" periods in history.

Speaking to the BBC, he said that in order to survive the new era some hospitals will have to merge with adjacent trusts, possibly resulting in cut backs to some services, but couldn't foresee any hospital in England having to shut down completely. 

Some hospitals are looking at taking over community services to remain competitive, while other will put themselves in the hands of private organisations, he said.