NHS service change plans will face stricter controls

Health secretary Andrew Lansley said ongoing and future proposals must focus on improving patient outcomes, consider patient choice, have support from GP commissioners and be based on sound clinical evidence. The Department of Health said “clear standards” for reconfigurations would be published in June.

HSJ revealed last week that Mr Lansley had called a halt to NHS London’s service change programme, Healthcare for London.

This week’s announcement means the future of any plans not yet implemented is uncertain. However, senior sources told HSJ they were hopeful that in many places it would mean a short review, rather than long delay or indecision.

Several primary care trust chief executives said they were already engaging GPs in change but accepted there were some areas where they were not.

They said any reconfiguration standards would have to take into account that changes may not be supported universally by local GPs, and should instead focus on ensuring meaningful engagement. One highlighted likely disagreement between GPs - for example divisions between GP federation leaders, local medical committees and “jobbing GPs”.

Former NHS Tower Hamlets chief Alwen Williams, now chief of the inner north-east London commissioning cluster, has been praised by the Royal College of GPs for successfully working with primary care clinicians.

She said she was optimistic north-east London’s reconfiguration plans would survive the Healthcare for London review because their development was clinically led.

But she acknowledged some PCTs had only paid lip service to GP involvement. She said: “Sometimes commissioning is seen as a bureaucratic process. You have to get up close and personal with contractors, listen to their concerns and work with them to resolve them.

She added: “Sometimes engagement can be code for ‘we have got clinicians in a room and informed them’. That is very different from them feeling they are in the driving seat.”

NHS Central Lancashire chief executive Joe Rafferty said: “Most PCTs will feel comfortable with GPs being empowered to create direction for change.”

But he said it was not yet clear how GPs would be accountable for their choices.

Royal College of GPs chair Steve Field, who has advised the government on primary care, said: “In some areas some important [reconfiguration] changes have been proposed, but the way they were communicated felt like they were being imposed without evidence. In other areas there is little evidence, and this will allow a review of what has been proposed.

Professor Field said: “I would call on GPs to take this opportunity to call up managers and work in partnership.”