The move to GP commissioning could exclude other clinicians from decision making while increased competition in the NHS will lead to cost cutting, reductions in quality and greater inequalities, according to the Queen’s Nursing Institute.

In its response to the Liberating the NHS white paper, the community nursing organisation said while abolishing targets would be welcome to take the pressure off parts of the service, nurses were worried about losing the benefits to patients from reduced waiting times.

It said the introduction of GP commissioning raised serious concern, because of “the GPs’ vested interests, the exclusion of other professionals who could have contributed usefully, and the complexity of the task which might create inequalities for the more excluded or complex patient groups”.

The QNI added: “The development of competition amongst providers – although understood in principle to be about making everyone strive to be the best - was widely condemned as likely to lead to cost cutting, reductions in quality and greater inequities in service provision.”

However, the institute said it supported proposals to increase joint working between the health service and local authorities, as this would “give patients a better experience of ‘joined up’ care, and more personalised services”.

Overall, the QNI called on the government to address community workforce issues.

Morale among community nurses was “undoubtedly very low”, it warned, because of reductions in staff numbers, downgrading of posts, the ending of innovative projects and forced early retirements.

It said: “There is no alternative workforce to deliver services, even under competition.

“It is essential that the workforce issues are addressed early on – including the falling numbers of community specialists, highly diluted skill mix, rapidly-increasing use of health care assistants to do nursing tasks, and exclusion of all but GPs from input into planning, commissioning and designing services.”

The response was drawn up by Queen’s Nurses, the QNI’s community nurse forum and the institute’s professional staff.