On 5 July 1948, in Manchester, Labour Secretary of State for Health, Aneurin Bevan announced the birth of the NHS.

On 27 February 2015, in Manchester, Conservative Chancellor of the Exchequer, George Osborne signed a piece of paper that would bring about the end of a National Health Service.

There is no longer an NHS in Manchester—it is now the MHS—the Manchester Health Service.

These two events are 67 years apart but signal huge differences in how healthcare will be provided to the population.

In a surprise announcement just weeks before a UK general election Mr Osborne signed a deal with the Greater Manchester Authorities—which includes Manchester, Bolton, Salford, Oldham, Stockport, Wigan, Tameside, Trafford, Rochdale, and Bury Council—a huge area. The actual deal can be read here. It hands over £6bn from central government to a new organisation to run health and social care services for 2.7 million residents in the Greater Manchester area. On the face of it this may sound attractive—no longer having Whitehall poking its nose into local health issues, but there is much to be concerned about.

The very fact this deal was hurriedly signed off just before a general election should ring alarm bells. Many local MPs had not been aware of how advanced the negotiations were and more shockingly the public had not been consulted or asked to make a decision on this huge change to their local NHS. To the horror of many, Councillor Jim McMahon, Labour leader of Oldham Council, told the BBC Sunday Politics programme on 1 March 2015 that “the changes happened too quickly to ask the public what they thought.”

Local GPs, who were promised by the coalition government to be more involved in local healthcare with the Health and Social Care Act, were kept in the dark and not given any say in the matter. There was no consultation with patients—those directly affected by the changes.

This all leads to the conclusion that it has been a done deal behind closed doors and rushed through prior to an election.

Local authorities often outsource services as they cannot provide them from their own resources—this was one reason why Aneurin Bevan didn’t offer healthcare provision to local authorities in 1948. Bevan ensured a national service was offered to all across the UK with no regional discrepancies and not at the whim of local councillors. This deal also significantly advances the risk of charging for services when social care is added into the mix of healthcare provision. Already in parts of Manchester cuts to services are occurring—as we have seen in Salford this week. With further severe cuts to local authorities in the coming years (promised by all major parties) where does this leave health services under this devolved deal?

Local patient groups, local GPs, local NHS staff, local MPs, national medical organisations, and patient groups need to be all over this deal like a rash. They need to ask where the consultation was and why democracy has been sidelined. They need to ask what the implications are for their care and what happens when local authority budgets are cut further in coming years.

The Manchester devolution deal is hugely worrying and has many risks attached to it. There is likely to be much debate on the deal in the coming months but one thing is for sure—the deal is signed, sealed, and delivered without so much of a debate or consultation with those it will most likely effect—patients and local NHS staff.

David Wrigley is a general practitioner in Carnforth, Lancashire. He is the co-author of the book NHS for Sale and NHS SOS.

Competing interests: I am a member of BMA Council and the BMA General Practitioners Committee. I am co-author of the book NHS for Sale and NHS SOS.