Anna Dixon: The NHS white paper – what do doctors think of their new roles?

Anna DixonThe past few months have been busy for anyone like me whose job it is to make sense of the government’s policy on health care. The coalition government launched a series of detailed consultations to accompany the health white paper “Equity and Excellence: liberating the NHS” back in August, and the 12-week period for consultation has now closed.

Initial reactions to the white paper were broadly positive. While voicing our concern about the abolition of primary care trusts and the transfer of commissioning to GPs within a fairly short timescale, we and many others welcomed the idea at the heart of the government’s proposal to put clinicians in charge. Given the proposed reduction in management roles, clinicians will be vital to successfully implementing the reforms. A look at the consultation responses from the main professional bodies suggests the government has yet to get clinicians fully on board. The British Medical Association (BMA) and the Royal College of Nursing (RCN) have both emphasised the risks involved in the reforms. They give some backing to the proposals, mostly centred on supporting the idea of empowering patients and clinicians, but they each caveat this with a list of risks. Even the Royal College of General Practioners, which is generally more positive on the reforms, qualifies its support for greater GP leadership and influence with the warning that training, time and resources are necessary to make it a success.

We wanted to find out more about the views of front-line clinicians, so we teamed up with to survey 1000 of their members. The majority of doctors who responded to the survey did not believe that the reforms would empower patients and doctors – a goal that all the organisations expressed support for in their responses.

Half of the doctors we surveyed were concerned that the NHS would not be able to maintain its focus on increasing efficiency while implementing the reforms – a key risk identified during the consultation. Doctors identified a number of factors that they believed would help meet the productivity challenge, including greater collaboration across health services and professions. But views were mixed when asked whether the reforms will encourage closer working.

The majority of GPs we surveyed were confident that there were GPs locally with the capacity to lead commissioning consortia. It seems that concerns expressed nationally about the willingness and ability of GPs to take on their new responsibilities are not shared by the front line.

The success of the reforms will ultimately depend on whether clinicians take on greater responsibility for ensuring high-quality, patient-centred care. Our survey has shown that ministers have a lot of work to do to convince doctors that the reforms will improve patient care.

Unless doctors and other front-line workers are brought on board and develop a clear understanding of how the reforms can improve patient care it is difficult to see how they will deliver against their objectives.

Anna Dixon is director of policy at the King’s Fund.

This blog also appears on the King’s Fund website at