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NHS reform... have your say

Thought-provoking comments on the impact of the NHS White Paper, Equity and excellence: liberating the NHS

The NHS logo, half against a yellow background, half against a blue backgroundIn its White Paper, Equity and excellence: liberating the NHS,  the Government set out its long-term vision for the future of the NHS. 

The reorganisation will see England's 35,000 GPs taking a far greater role in commissioning services for their patients. They will be in control of £80bn of taxpayers' money and will need to form consortiums by 2013. There will be no opportunity to opt out of the system. Further details can be found in the news story, NHS overhaul plans unveiled


In an exclusive comment to PMLiVE, Head of health at Ipsos Mori, Sarah Phillips, said:

"Whatever anyone thinks about it, the Health White Paper will shake up commissioning in the NHS and have a substantial impact on the way services are delivered to patients. Its aim is to bring commissioning closer to those who work on the frontline with patients, and who know the patient needs best. It provides a unique opportunity for GPs to make a difference to the health and wellbeing of their patients.

"However, commissioning healthcare services is not an easy job, and I am sure most GPs did not sign up for a role in primary care to have to think through improvements in care pathways. Some of the questions the White Paper has yet to answer are what support there will be for GPs to fulfil this role, and crucially is this a skill set GPs have or want to have?

"While it is true that GPs are at the centre of the community and have the best interests of their patient at heart, how will they engage with the more strategic decisions about the direction of the NHS? For instance, in times of tightening budgets, how will they make the decisions about where to disinvest – and how will they be held accountable for those decisions? What's more, how can they drive through change on their own, or even in consortia? There are no economies of scale at play here, and it will be difficult for them to see how to they will identify and improve the care provision of a small number of their own patients, who on a larger scale may have an important set of unmet needs.

"The issue here is the speed at which these reforms are being driven: without a pilot phase, where is the proof of concept that this will actually work? The paper will change the way things are done, and it is a huge gamble for Government. The empowerment of patients and GPs is a good thing, but how this will work in practice has yet to be answered."

Have your say...

What do you think of the government's plans?

Joined the debate in the PMLiVE LinkedIn group at or email your comments to 


Other responses to the Health White Paper:

Dr Richard Barker comments on the NHS White Paper: Equity and excellence: liberating the NHS 

On devolution of power to GP-led consortia
This has the potential to drastically change the landscape in which we operate. For the last few years industry has focused on PCTs and secondary care Trusts as the holders of the purse strings, but now the intention is to move these to GP-led consortia, which will require that industry switch the pattern of its relationships over the next two years. 

One area of concern is that there is a lack of experience in certain less-prevalent disease areas such as orphan diseases and some rarer cancers. To ensure we do not exacerbate the postcode lottery scenario, re-skilling is required. We would like to be a discussion partner with government in terms of defining how these conditions are commissioned. In recent years we have been involved in several joint-working initiatives with the NHS in the treatment of long-term conditions such as COPD and have shown how early intervention and diagnosis can drastically reduce hospitalisation. As industry, we can help this new commissioning era distribute learnings of how pathways work. Industry representatives who call on GP consortia will need now to be more economically savvy in order to deliver an economic as well as a clinical argument. 

For some time I have been saying that industry needs to view the NHS from a multi-level account management perspective and, for those companies that have done this, it is not a case of re-skilling, but rather redeploying the skills they have developed already rapidly and on a broader scale, ie more people must be equipped with both the clinical and economic knowledge to be an NHS relationship manager. 

On patient choice
The White Paper keeps hold of the NHS Constitution and places strong emphasis on patient choice. Industry is already doing a great deal of work with patient organisations, and we must ensure that the work we continue to do with patient groups helps them understand their rights. 

On pricing and reimbursement
There is little talk in the White Paper about price and reimbursement. It does state however that in future pricing should reflect value, which is what the new Government has been saying all along and a concept that we as industry support. But like with most things, the devil is in the detail. We are ready to start the conversation about what constitutes value. It is encouraging to hear the government talk about value in the context of increasing access, bearing in mind that the UK has prices that are amongst the lowest in Europe, but it is out of line with Europe on uptake of innovative medicines.

On quality standards and new approach to commissioning
The role of NICE will change to that of setter of quality standards, which has the potential to make this new era of commissioning a positive one for industry. If we can work with government on how this new commissioning era will weave in best practice for the treatment of disease, it will be a positive step, however if we are confronted with a scenario where we must solve the same problem 500 times, there could be even greater differences in how patients are treated in one area of the country to another. The White Paper calls for consultation. Industry has all to play for and we hope Government will engage enthusiastically and consult with the ABPI to achieve these goals. 


In a general statement, chairman of the Ethical Medicines Industry Group (EMIG) Leslie Galloway said:

"EMIG welcomes the publication of the White Paper, which sets out ambitious proposals for restructuring the NHS and the role that GPs will take in commissioning treatments for patients. As the representative body for over 100 small to medium sized pharmaceutical companies, we look forward to working with Government to ensure the proposals encourage small-medium companies to invest in future innovation as well as effective co-operation with the NHS, especially during this period of considerable financial constraint for smaller businesses.  

"Improved patient access to treatment must be at the heart of these plans for the NHS. We will consider today's proposals – particularly GP commissioning – through this lens and look forward to working with the new Government to address the issue". 


Ahead of the publication of the White Paper, independent think-tank, the Institute for the Study of Civil Society (Civitas), predicted that the Government's health initiatives could set the NHS back by up to three years. Civitas says NHS shake up could be costly provides further details of the institutes's predictions. 

19th July 2010


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