It’s four months since the Department of Health published its Health White Paper for England, during which time seven additional consultations have emerged, and hundreds of organisations have responded.   But despite the growing volume of White Paper-related material, not to mention the ambitious timescale set out to “liberate the NHS”, much of the picture is yet to come into focus.

In the BMA’s response, we emphasised our concerns about the potential damage that could be done by continuation of the internal market in the NHS and plans to accelerate competition, such as forcing all trusts to attain foundation status – as well as elements we thought have the potential to bring improvements – such as clinician-led commissioning.  But just as importantly – albeit less newsworthily – we said that there were far too many aspects that remained unclear. 

To many of the questions doctors are asking about the impact of the changes for them and their patients, the honest answer is that we do not yet know.  It is too early to say in detail what GP consortia will look like, the size of the patient populations they will serve, as well as how exactly quality in secondary care will be measured, or how the new NHS will provide training.   It is unsurprising therefore that much of the medical profession is yet to make up its mind – the feedback we have had so far from our members, and a survey by the King’s Fund, both indicate that while some doctors are strongly opposed and some are really enthusiastic, the majority intend to wait and see.

It is perhaps worrying that so much remains unclear, but we should also see it as positive – there are still opportunities to influence the plans – both now, and when legislation is published.    That’s why it’s so important for all doctors – not just GPs – to get engaged now in influencing the direction of these reforms.  The BMA has been clear in its opposition to some of the proposals – but we also acknowledge, that in some areas, some of what the government has proposed is what doctors have been calling for for years, and it’s up to us to help develop it to make it work.  As much of what happens will actually be shaped at a local level, it makes sense for doctors to get to grips with the issues in their own areas now. 

We have produced initial guidance for GPs, consultants and SAS doctors on what the white paper could mean for them, available at www.bma.org.uk/nhswhitepaper and I recently answered questions from members in a live broadcast.  We are now gearing up for much wider engagement as more details emerge to ensure we draw on the views and experience of as many doctors as possible to ensure the best possible outcome for the profession and, even more importantly, patients and the public. 

Hamish Meldrum is the chairman of council, BMA