NHS REFORMS: NHS commentator, Roy Lilley, on why GPs stand to make millions at the expense of patients

A leading NHS commentator has voiced fresh concern over the Government’s proposed health reforms, warning that GPs could choose not to improve services and instead line their own pockets.

Speaking at last week’s IHEEM Healthcare Estates Conference, broadcaster and health policy expert, Roy Lilley, reiterated fears that the proposed new commissioning environment, and the rules around payments to GP consortia, mean medics could be accused of conflicts of interest and stand to make money off the back of patient choice.

He told delegates: "As it stands there is nothing to stop GPs owning the services they commission from.

If I go to the GP with a bad hip and they prescribe physiotherapy and painkillers and not a hip replacement, I won’t know whether they are doing that because it is better for them or better for me. They could send me to Bunions R Us, but are they doing that because they have a vested interest in it?"

The issue of quality premiums - effectively a bonus GP clinical commissioning groups will receive for achieving improvements in patient outcomes - was also heavily criticised.

Lilley said: "Under the proposals, how they spend this money is likely to be discretionary. They could plough the money into making services better, or they could buy their mistress a new fur coat."

And he called into question the impact the Care Quality Commission (CQC) and HealthWatch organisations would have in ensuring equality and fairness across the new system. In a scathing attack he said: "The CQC will just turn up and count the dead and HealthWatch is such a load of rubbish, I can’t even be bothered to talk about it."

His comments came after he revealed that, contrary to popular belief, Andrew Lansley’s health reforms were not hastily put together, but had been in the pipeline for at least six years and should not have come as such a shock.

He told the conference: "We have had huge outrage about the bill from ordinary people, not just staff and unions. Their problem is that they see no narrative. The politicians are saying the NHS needs to change, but they are not telling people why. There is no explanation that ordinary people can understand. It came as a surprise to the public and they felt like it was being smuggled in."

But he added: "To find the narrative, you need to go back to the bus bombings in London in 2005. Two days after that happened, Lansley, then in opposition, made a speech and set out what the shadow government would do and what he thought the health service would look like. But, because of the bombings, there was no press coverage."

During this speech Lansley outlined a vision that included maximising competition, transferring risk to the private sector, setting out firm standards, specifying universal service objectives, providing quality information, and ensuring equality of access; a vision that largely underpins the current proposals.

"He has had this planned since then," Lilley said.

And the Liberal Democrat coalition partner was also no stranger to the reforms, with the now Deputy Prime Minister, Nick Clegg, saying several years ago: “I think the breaking up of the NHS is exactly what we need to do to make it more responsive.

Lilley said: "Again, no one noticed this because at the time no one listened to Nick Clegg.

But, once in power it was just a matter of weeks before Lansley put his long-held vision into practice.

Lilley said: "Further back in his career, David Cameron worked in the Conservative Party’s research department and the head of that organisation at the time was Andrew Lansley. Because of this relationship Cameron trusted Lansley. It wasn't until three or four months after the bill was drawn up and the focus group responses showed unprecedented opposition that he started to take notice."

And he claims that what the country has been left with is an ill thought-out plan that could modernise the service, or in contrast leave patients high and dry and GPs in the driving seat.

Paul Kingsmore, IHEEM president, said NHS employees were also wary of the reforms, adding: "The change in the Government and its approach is, I think, probably more change than we wanted and more than we anticipated. A lot of us are uncomfortable about this."