The UK Government has unveiled the next steps in its plan to reform the National Health Service but has come in for criticism from the British Medical Association for not listening to its concerns.

Liberating the NHS: Legislative Framework and Next Steps, the government’s response to its consultation on the NHS White Paper for England set out in July, has been published with the claim that £89 billion will go direct to primary care trusts for frontline services, an increase of £2.6 billion, or 3% higher. The coalition argues that it has developed its thinking in the light of the 6,000 responses received as part of its consultation which "demonstrated support for the principles set out in the White Paper". 

The government noted that 52 GP consortia have signed up as 'pathfinders' to manage their local budgets and commission services for patients. In total, these involve 1,860 GP practices and cover around 25% of the population, 12.8 million people.

It has also published the PCT Allocations and NHS Operating Framework for 2011/12 to prepare for transition to the new system of GP commissioning. This includes streamlining PCTs into clusters, working with GP practices and emerging GP consortia on commissioning as  well as reducing running costs. The framework also calls on the NHS to prioritise the implementation of earlier diagnosis for cancer patients.

Health Secretary Andrew Lansley said that in order to meet rising demands and deliver improving outcomes for patients, "we need to get the best value from our protected health budget and make every penny count". He added that this means 'cutting out waste, reducing bureaucracy and simplifying NHS structures so that we are able to invest more in improving frontline care". NHS Chief Executive David Nicholson said the coming year will demand much from the service and "the challenge for us is to maintain and improve quality, keep strong financial control and create a new system that improves outcomes for patients".

 GP concerns 'disregarded'

The BMA, however, is less impressed. Its chairman, Hamish Meldrum, said “there is little evidence in this response that the government is genuinely prepared to engage with constructive criticism of its plans for the NHS". He added that "most of the major concerns that doctors and many others have raised about the White Paper seem, for the most part, to have been disregarded", claiming that "the response completely fails to acknowledge that proposals to increase competition in the NHS will make it harder for staff to work more co-operatively".

He went on to say that "while we still believe that clinician-led commissioning can improve patient care, this document does not provide assurance that it will be implemented effectively". Dr Meldrum also expressed concern about the pace and scale of the reforms, saying that "change of this magnitude was always going to be a challenge and the worsening financial pressures on the NHS, coupled with the ambitious timescale and lack of detail, make the present strategy very risky".

He added that "given the latest inflation figures, we do not accept the government’s claim that it is increasing real terms funding for the NHS". Specifically, Dr Meldrum said "the stated 3% 'increase' in funding for PCTs includes £1 billion already announced to cover additional social care responsibilities and masks the fact that hospitals will have to do a lot more work to achieve the same income".

He concluded by saying that "patients across the country are already discovering that local services are being rationed to achieve efficiency savings, and there are likely to be further NHS cuts on a scale we have not seen for many years". The BMA will consider the government’s response in detail, "but our initial reaction is that they seem committed to charging forward with these changes despite the warnings and despite the risks.”