The government must reconsider its plan, set out in the Health and Social Care Bill, to separate the commissioning of primary and secondary care in the NHS, an influential panel of MPs has urged.
The latest report of the House of Commons Health Committee's inquiry into NHS commissioning, published today, also says that local commissioning authorities should not be given the proposed title of "GP Consortia" because, they say, this is misleading, and they should instead be referred to as "NHS Commissioning Boards." Moreover, the government should scrap its plans to establish Health and Wellbeing Boards, the MPs add.
The Committee members say that the evidence they received during their inquiry into NHS commissioning emphasises the importance of integrating primary and secondary care, with even the Secretary of State for Health, Andrew Lansley, telling them that: "we know that the best way to design those [community-based] services is with primary care and secondary care working together, and not shift the resources into primary care and let primary care do it and simply cut the budget at the hospital."
But this evidence runs "counter to the direction of policy," the Committee members point out, and they state in their report that: "if integration of primary and secondary care commissioning is important, then separating them in order to support the proposed system architecture may cause significant harm to the commissioning system as a whole, and should be reconsidered."
Moreover, the report also recommends that NHS commissioning authorities should assume responsibility for commissioning the full range of primary care, including services such as pharmacy and dentistry as well as general practice.
Said Committee chairman Stephen Dorrell: "ever since 1948, the NHS has suffered from an artificial distinction between primary and secondary care. Instead of entrenching this distinction further, this is an opportunity to abolish it for good, and create a single, integrated health service which is able to provide properly coordinated health and social care to all patients."
"It is an opportunity to deliver greater efficiency and high quality at the same time. It is a 'win-win' - what is the argument against?" added Mr Dorrell, who is Conservative MP for Charnwood.
The Committee's latest report also says that general practitioners (GPs) should be in the majority on local NHS Commissioning Boards, but that nurses, hospital doctors, public health experts and local communities - the latter in the form of an elected councillor or directly-elected Mayor - must all be involved as decision-making alongside GPs in commissioning and should therefore also be represented on the Boards.
"We believe this broadening of the case for commissioning is vital if we are to achieve the changes that are necessary to allow the NHS to deliver properly coordinated healthcare," said Mr Dorrell.
However, the NHS Confederation says this proposal causes it concern, pointing out that putting "local politicians on GP consortia boards is completely contrary to the government's rhetoric about removing politics from the NHS."
"There are very few questions to which the answer is 'more politicians,'" said the Confederation's acting chief executive, Nigel Edwards. "We're all for more scrutiny of GP consortia decisions but there is a point where political involvement becomes unhelpful to the running of an organisation."
The MPs' call for full-integrated commissioning of primary, secondary and social care is "a radical idea with lots of potential" that "deserves full consideration," Mr Edwards added. However, he said, "one of our worries with the reforms is the potential for conflict of interest among GPs where they are commissioning services that they also provide. This could be even more of a concern if the Committee's proposal was implemented."
