Domhnall MacAuley: The day the brakes went on

Domhnall MacauleyThe consortia dream screeched to a halt. As I watched breakfast TV in the airport lounge on my way to the GP forum, the controversial health reforms were unravelling. The forum meeting was entitled “Commissioning Consortia: Examining the comprehensive business and clinical issues for a successful practice-led future” and suddenly, it seemed inappropriate. The health bill was going into pause, facilitated by a natural break in Parliament, and the Health Select Committee had major criticisms and suggestions. Overnight, the game had changed.

The mood was subdued. These were the true believers, the early adoptors, the committed, and they had come to this meeting in expectation of major change. I was due to chair an “open surgery” session reprising the morning session and discussing the major issues with a panel including Sir Neil McKay, Chief Executive NHS East of England; Dr Lise Llewellyn, Chief Executive NHS Berkshire; Dr Paul Singer, a GP and Chair of Luton Commissioning; Vanessa Bourne of the Patients Association; together with Dr Pauline Brimblecombe from the National Clinical Commissioning Network who was co-opted on the day. During the morning, even during the talks on consortia accountability, pathfinder think tanks, QIPP, and consortia design challenges, I could feel a certain anxiety: How would GPs cope with saying “no” to patients, how would GP consortia bring errant colleagues into line, and looking at the flat funding in the context of increased costs (presented by Ben Richardson, a partner in McKinsey), how would consortia survive?  The panel were upbeat and robust- it could be done, GPs had a responsibility to make it work, could make it work, and there would be strategies to manage GP outliers.

Informally, there were complimentary comments on BMJ coverage, although there were criticisms that we had been too negative and our content weighted too heavily by policy with insufficient voice given to doctors. But, there was also some criticism of representative organisations;  that they were not always representative.

Stephen Dorrell was scheduled to speak immediately after lunch. And, to his credit on such a tumultuous day, he came and almost conquered.  He was measured, reasonable, and persuasive. He supported integrated packages binding primary, secondary, and social care. It seemed entirely appropriate that future consortia, or whatever they would later become,  be guided by all of the stakeholders. He certainly endorsed the primacy of general practitioners in the organisations but no one could really argue with his reasoning that they should have input from hospital specialists, nurses, social care, and the local community. Clive Peedle, a consultant oncologist and council member of the BMA, did not disagree with the principles. But he felt the health reforms had embraced a competitive ideology that was incompatible with health care, that change was enforced, and he disagreed with the politics of reform;  the creative destruction and supply driven economics.

It’s not over yet. And, in view of the health committee report , it is, perhaps  opportune  to take  some time out. The uncertainty is difficult but might be best for patients in the longer term.

Domhnall Macauley is primary care editor, BMJ