With Parliament approving the latest NHS Reform Bill, business guru Sir Gerry Robinson fears that this may lead to the end of the NHS, as we know it.

Sir Robinson’s comments come after he spent six months reviewing the health of the NHS. The core reform will see and end of Primary Care Trusts (PCTs) which currently decide where NHS money is spent.

Under the proposed bill which will now go to the House of Lords for debate will see PCTs being replaced by GP led Clinical Commissioning Groups who will make decisions about patient care and whether the public NHS or private care services best meet those needs.

Sir Robinson, said, “I have been doing my own listening, meeting the people who would have to make the changes work – our GPs. And I have come away with grave concerns over the very future of our beloved health service”.

A key part of the new reforms is offering patients a choice between NHS and private care. But at a GP practice in Hackney east London, Dr Deborah Colvin told me, “She is worried that this could unravel schemes like her diabetes project”.

“If a patient said ‘I want to see a diabetic nurse from that company and a dietician from this company,’ it is going to make my life a nightmare in terms of different payment systems, different forms”.

“I would never get everybody together to talk together and that would not be best for patients,” said Dr Colvin.

Sir Robinson added, “She is proud of her scheme she devised for local diabetic patients that brings a number of local agencies into the practice to deal with this complex illness”.

“What worries me, and what I do not think will work in the long run is to use outside providers because they appear cheaper in the short term – but that are not part of a properly managed, strategically planned system of care”.

“I think there is a place for outside providers, but it needs to be carefully managed.”

“When I met Health Secretary, Andrew Lansley, he defended the reforms but acknowledged that patients need to know what is being proposed.”

“You have got 50 million patients for whom it (the NHS) is always going to be important, so when they hear that the service is going to be fragmented, is it going to be safe in the future, they need to know it is going to be safe”.

“Despite criticisms of Mr Lansley’s plans, I also found grassroots support for wholesale change,” said Sir Robinson.

According to Dr Kosta Manis, a GP in Bexley, “The changes are better for patients and better for NHS finances. And key to that is the central reform – giving GPs substantial control over budgets instead of the current PCTs”.

“And that means control over how much they pay for services from the NHS and how much they buy in the private sector”.

Some of the concerns raised by supporters of the reform are that under the current system money is being wasted when the service could be provided cheaper and quicker than the same service provided in an NHS hospital.

For example Dr Manis was concerned that angiograms were often routinely ordered at the local hospital because they were a source of income for the NHS hospital, not because they were absolutely necessary.

The Health Secretary agreed that the current system can encourage waste. “It happens because of the way the payment system in the NHS works at the moment – because it pays for activity. So of course if you incentivise somebody just to do more work, they will do more work,” Mr Lansley said.

“This naturally provides great potential for waste if hospitals are not vigorous in weeding out unnecessary procedures. I also have concerns that GP reforms would affect other elements of the NHS, possibly even leading to hospital closures if hospital incomes are significantly reduced as money is spent instead on private health care,” said Sir Robinson.

Mr Andrew Lansley, said, “If the people who are commissioning the services want the services to be there, if the public want the services to be there, if it is transparent that the service is in demand it does not actually make sense to just shut it down”.

In closing, Sir Robinson said, “I think the stakes here are huge. Who is going to be managing the big picture? Unless somebody really does grab this thing at the centre and has the courage to make unpopular but right decisions then I fear this could spell the end of the NHS”.

With the controversial NHS Reform Bill now entering the House of Lords, there are still serious concerns from those within the profession, the general public and leading business gurus such as Sir Robinson who feel that the Reform Bill will be the beginning of the end of the NHS, as we know it.

With increased competition from the private sector, NHS hospitals could be in the situation in the future where costs take a priority over patient care in order to win contracts and treat patients. However there are also those within the profession that believe a more open healthcare with competition between NHS hospitals and private sector healthcare providers will see patient care improve, less waste and a more efficient service for patients.

However, despite the benefits being put forward by supporters of the Reform Bill, there are many within the profession that are concerned that the NHS of the future as it goes through radical change could see more hospitals closing seeing further job losses of key workers within the profession such as doctors, front-line support staff and managers.

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