BMA comes out against Health Bill

The British Medical Association has moved to outright opposition of the Health and Social Care Bill that will enact the government’s latest NHS reforms.

In a briefing paper issued this morning, the doctors’ union says the BMA Council took the decision “to move to a position of opposing the whole [Bill] at its meeting on two weeks ago.

“This means the BMA now has a single object in relation to the Bill – which is for it to be abandoned.”

The move represents a significant hardening of the BMA’s stance. When the ‘Liberating the NHS’ reforms were first unveiled in July last year, the BMA was cautiously supportive.

Its position was opposed by some members, leading to a special representative meeting to discuss the reforms – the first held since the BMA battled the introduction of the internal market to the NHS in the 1990s.

The SRM called for the bill to be withdrawn or significantly amended, but stopped short of opposing it in its entirety.

The BMA said this morning that it had moved beyond that position because the government had failed to respond to significant concerns, despite the ‘listening exercise’ that it asked Professor Steve Field to conduct in the summer and the changes to the Bill that it made in response.

It also said that “doctors’ concerns about the reforms have continued to grow rather than diminish, because of what is actually happening on the ground.”

The BMA’s initial stance was influenced by GPs who, while they might have had reservations about some aspects of the reforms, liked the idea of gaining control of local commissioning.

However, the changes made as a result of the listening exercise, and guidance issued subsequently by the Department of Health, have tightened central control on the size, constitution and role of clinical commissioning groups.

“Vast amounts of guidance on how the system will work in detail are being rapidly developed which appear to be constraining clinician-led commissioning within a bureaucratic straightjacket,” the briefing paper says.

“A recent example is new rules on how CCGs will be able to access commissioning support, which could leave [them] with no choice but to use large, commercial organisations.”

The BMA is particularly concerned that support for IT and information collection and analysis could be pushed into the private sector, giving the analysts more influence over the direction of local services than the GPs and other clinicians using it.

The BMA paper also complains that the implementation of the reforms has been “chaotic” and unplanned because elements were pushed through before the Bill completed its passage through Parliament.

Cluster strategic health authorities and primary care trusts have emerged, and are starting to look like permanent parts of the new commissioning set-up; while CCGs have been told to merge to become big enough to be viable.

The paper also says the reforms continue to lack a clear vision and coherence; while “an increasingly massive amount of management and clinical time is being taken up with the process of reform, diverting attention from the pressing financial challenges facing the health service.”