Mike Waites: From cradle to grave... a lifeline for the NHS or the end of a great ideal?

More than 60 years on and it falls to the grandson of then BMJ Editor Hugh Clegg to play an instrumental role in the most dramatic changes to the NHS since those momentous days.

Curiously, Nick Clegg and his Tory partners may achieve what Bevan never did and effectively nationalise GPs by making them responsible for £80bn of NHS spending.

The key questions are: will it work and should it happen now?

Health Secretary Andrew Lansley argues GPs should be given the key responsibility for making spending decisions since they are closest to patients and trusted by them. As gatekeepers to healthcare, GPs are indeed a cornerstone of the NHS and the changes could strengthen the link between clinical and financial decision-making – even if many GPs might resist the implications of that. But there are many other front-line staff whose expertise and decisions directly affect patients and spending.

Midwives, for instance, have the closest links with pregnant women. The Royal College of Midwives lobbied successfully for maternity services to be kept out of GP control and remain outraged that Mr Lansley changed his mind to give GPs the final say over shaping maternity care.

Specialist nurses know the detailed needs of patients with long-term conditions, while people with mental health problems receive most of their care in the community from a range of key workers.

Then there are consultants and other hospital doctors whose decisions to carry out tests, to admit patients, to approve referrals and to perform operations also have major implications.

On top of this, there are also local authority social care teams whose decisions also heavily impact on the NHS. All should be handed a voice. Yet it is GPs alone who will decide how to shape services under the current blueprint.They are being handed this without any evidence that they are up to this accountancy remit that is far removed from their medical training.

Neither has it been explained how giving powers over £80bn in spending to GPs, who are independent businessmen and women for the most part and who are not directly employed by the taxpayer, safeguards the public purse. Claims that GPs will somehow police each other in terms of driving up standards and delivering efficiencies in healthcare, for instance by cutting high hospital referral rates of some or reducing spending on high-cost branded drugs by others, are highly speculative.

Yet there remain real doubts about how GPs will themselves be policed. It is claimed the creation of GP consortia will also save vast sums spent on NHS administration. But the history of NHS reorganisations proves they never save as much money as expected.

In Yorkshire there will be more than 30 consortia, compared to 14 existing primary care trusts. All will need a bureaucracy to support them which may well mean increased administrative costs. But at the heart of the debate remains how best to spend increasingly limited NHS resources against a background of soaring demand. Lower cost solutions need to be found to provide care more effectively.

Inevitably, cherished but expensive hospital services will close. As it stands now, these big decisions are made by NHS managers and, ultimately, Mr Lansley. Under the proposals, they will be made by GPs who will also decide which drugs to withhold or which operations to axe.

Little wonder Clare Gerada, chairman of the Royal College of General Practitioners, has raised the prospect of demonstrations outside GP surgeries over controversial decisions as they become the “new rationers” of care.

The changes will come at the same time as the NHS mounts its biggest-ever programme to save up to £20bn by 2015. This will be incredibly difficult to achieve and mean a great deal of pain.

Yet, instead of concentrating on the critical task of doing more with less, the NHS is being thrown into organisational turmoil.

There cannot have been a worse time in the last 60 years to embark on such fundamental changes. It represents a huge gamble by Ministers. For the reforms to have at least some chance of succeeding, there must be involvement of other clinical staff – besides GPs – in the decision-making process and a slowdown in the re-organisation that is, currently, prioritising the financial firefight.

Prime Minister David Cameron is fond of repeating that “no change is not an option”.

Patients, who last year gave the NHS record-high satisfaction ratings, will not forgive him if his change is an option which causes irretrievable damage.

Hugh Clegg saw the NHS in its cradle. His grandson may be remembered for setting it on course to its grave.

Mike Waites is the Yorkshire Post’s health correspondent