NHS overhaul has 'risks', doctors warn

Re-organisations of the NHS are nothing new – doctors, nurses, and managers are used to adapting to one set of reforms, then being told by a new set of politicians that everything has to change again, writes Dr Hamish Meldrum, chairman of the British Medical Association Council, for Channel 4 News.

But the shake-up being set out in the Health and Social Care Bill for England is likely to be more fundamental than anything we've seen before.

As well as abolishing the current structure of Primary Care Trusts, and giving doctors a greater role in the shaping of NHS services, the legislation is set to create new duties to promote competition. Commissioners of care will be obliged to tender contracts for services to any willing provider, including profit-making companies.

The NHS reforms and you: what difference will changes make to patients? 

'Worryingly ambitious timescale'

These changes – all to be achieved in a worryingly ambitious timescale – carry a number of risks.

In an NHS increasingly governed by market forces, and already under massive pressure to deliver £20 billion in cost savings, large commercial outfits will be able to use their size to undercut on price, which could shift the focus away from quality and risk destabilising local NHS services.

The shake-up is likely to be more fundamental than anything we've seen before. Dr Hamish Meldrum, BMA Council Chairman

My belief is that commissioners of care should be free to choose the most appropriate providers, without fear of legal challenge. As the Prime Minister said this week, public services are important because they affect people's lives. The people the NHS cares for often have very complex health needs and get the best services when teams of GPs, hospital doctors and other health professionals can work together as a team, not in competition.

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We do not disagree with the Government's stated aims – more power for staff to shape services, greater say for patients, and improved efficiency – but they are unlikely to be achieved if the various concerns that staff and a growing number of experts have raised are not taken on board.

Dr Hamish Meldrum is the Chairman of the British Medical Association Council

Watch: Health Secretary Andrew Lansley debates the changes with Jon Snow