Responses to the government’s consultations on its white paper Equity and Excellence – Liberating the NHS are rolling in, and while its core principles have won hearts, fears remain over the delivery of many of its key proposals.

After considering the coalition government’s radical plans for healthcare reform, the NHS Confederation, speaking on behalf of more than 95% of organisations that make up the NHS, has called for action on the design and implementation of the government’s plans.

The organisation says it supports the government’s objectives of empowering patients and involving clinicians more closely in decision making, but warns of “significant risks, worrying uncertainties and unexploited opportunities” that need to be tackled if the plans are to work as intended.

“It is imperative that the government does everything possible to address what is a significant list of uncertainties about how the new system will work,” said Nigel Edwards, acting chief executive of the NHS Confederation. “The fact of the matter is that the government is planning to build a very big new machine - at great pace - but no one can be quite sure what will happen when it is switched on.”

The group has submitted no less than 40 suggestions for improving the new system and has constructed a ten-point action plan for successful management of the transition, and it calls on ministers to “ease the very deep worries” people have about the changes ahead. “We are about to embark on a hazardous journey at a time when resources are hugely stretched. The risks are very real indeed,” Edwards said.

A key concern is that, under the plans, the new GP consortia – which are to take over commissioning of services – do not seem to be clearly accountable to patients and the public, and it says clarification on their relationships with member practices, the NHS Commissioning Board and health and well-being boards is urgently needed.

The NHS Confederation believes GP commissioning has the potential to be “hugely productive”, but cites major concerns that, with 45% management cost reductions over the new few years, GPs will not be able to develop enough capacity and capability in time to carry out this complex task effectively.

Elsewhere, the group warns that skills and experience from the soon-to-be-axed Primary Care Trusts are likely to be lost, and so urgent action is needed to “retain good staff and preserve organisational memory”, and notes that the substantial culture change needed for the successful implementation of the government’s plans has been underplayed, and so “more needs to be done to explain the shift away from top-down management and to help the public, the NHS, media, and MPs to understand its implications”.

Meanwhile, in its response to the white paper consultations, the Royal Pharmaceutical Society of Great Britain Medicines has stressed that, as medicines are the most common health intervention patients receive from the NHS, pharmacists should be involved in all aspects of healthcare going forward.

And it has also voiced key concerns, particularly over the regulation of healthcare providers and commissioning of pharmaceutical services.

The Society has called for the role of Monitor to be “precisely defined” in relation to pharmacy, as it is worried that, as any organisation licensed with the watchdog also needs a licence from the Care Quality Commission, pharmacies could potentially be regulated by three different regulators, each with different focuses and fees.

Fragmentation of pharmacy services purchasing?

It also highlights the potential fragmentation of commissioning pharmacy services under the proposals. “Services will be commissioned by the NHS Commissioning Board in relation to the national contract, GP consortia in relation to local services and local authorities in relation to public health services, [which] means different elements of a whole service may be commissioned by different organisations”, it warns.

In addition, the group notes it is also “very concerned” over the future of commissioning for pharmacy-led specialist services, such as the provision of medicines information and pharmaceutical quality assurance. “We want to see these services commissioned nationally through the NHSCB to ensure quality standards are applied equally across the NHS”, it stressed.

In its response to the consultations, the NHS Alliance has generally welcomed the move towards a health service that is clinically commissioning led, and emphasised that, if the changes are to go ahead GP practices and PCTs should start working together now to accelerate the transition.

“The direction of travel is right,” said the Alliance’s chief executive Michael Sobanja, but “concerns around the details of implementation and timescale need to be carefully considered”.

“The pace of change may be daunting but we must ensure we get it right. For that to happen, flexibility and a focus on culture, behaviour and outcomes, at all levels in the system, will be paramount,” he concluded.

 The consultation period has now closed.