Plans for NHS market put vulnerable at risk, warn clinicians

Plans to increase competition in the NHS risk harming the care of vulnerable patients, health professionals warned today as the government published its Health and Social Care Bill.

Clinicians said the proposals risked fragementing services and damaging quality to the detriment of the care of groups such as people with mental health problems.

The bill would mandate GP consortia, which will be responsible for commissioning healthcare, to open up services to tender to any willing provider, so long as they are registered with the Care Quality Commission and economic regulator Monitor. It would also enable providers to compete on price by enabling the government to set a maximum – rather than a fixed – price for some services.

“There is a danger that, in the new system, services will go to the cheapest provider at the expense of quality,” warned Dr Laurence Mynors-Wallis, registrar of the Royal College of Psychiatrists. “There is also a danger that, if a multiplicity of providers is delivering different aspects of care, that care may be fragmented and patients may fall between gaps in services.”

Dr Hamish Meldrum, chairman of council at the British Medical Association, was also critical: “Forcing commissioners of care to tender contracts to any willing provider, including NHS providers, voluntary sector organisations and commercial companies, could destabilise local health economies and fragment care for patients.

“Adding price competition into the mix could also allow large commercial companies to enter the NHS market and chase the most profitable contracts, using their size to undercut on price, which could ultimately damage local services.”

His fears were echoed by the Royal College of General Practitioners.

“The college is concerned that some of the types of choice outlined in the government’s proposals run a risk of destabilising the NHS and causing long-term harm to patient outcomes, particularly in cases of children with disabilities, those with multiple co-morbidities and the frail and elderly,” said its chair, Dr Clare Gerada.

“While the government has sought to reassure us, we have yet to be presented with sufficient evidence to underpin these reassurances.”

Mynors-Wallis also raised concerns about GPs’ ability to commission mental health services.

“The college would be dismayed if psychiatrists were not closely involved with local consortia of GPs in the development of mental health services,” he said.

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