VODG - Blog - The NHS White Paper, what's your view?

There are a few good things in the government's new health white paper. Citizens will be given a greater say in how the NHS is run, it says, and it will be less insular and work much better across boundaries, such as those with local authorities. Power will be given to the front-line, ie clinicians and patients. So far, so many fine words.

But, as disabled people and the voluntary sector that serves them know to their cost, the usual windy rhetoric of white papers is mere hot air if it is not backed up by the determination of all the interested parties to make it work. The "interested party" that has captured most interest this time round are GPs and historically the majority of them couldn't have been less interested in meeting the needs of vulnerable groups.

An unknown number of GP consortia will replace primary care trusts, receiving £80 billion of NHS funds for the privilege. They will be expected to spend the money wisely on, among other things, commissioning services for disabled people and people with mental health problems. Where is this wisdom to come from? Presumably not from GPs themselves, who often display the "insular and fragmented" mentality from which the white paper wants to escape.

The best hope is that GPs will buy in commissioning expertise from local authorities and good advice from the voluntary sector. These days GPs are at least aware of their own limitations: in a survey by mental health charity Rethink only 31% admitted that they felt equipped to take on mental health commissioning and more than half told Mencap that they needed guidance on meeting the needs of people with learning disabilities. There will be a duty of partnership between GP consortia and local authorities with the aim of ensuring "coherent and coordinated local commissioning strategies" across the NHS, social care and public health.

But GP consortia will be in the driving seat. If they don't like the advice they are getting from local authorities and others who know the score, they can ignore it. An NHS Commissioning Board focused on the medical model of care rather than the social model of support is unlikely to interfere. And it will have other worries, as the government seeks to take 45% out of the costs of "bureaucracy" and make efficiency savings of up to £20 billion over the next four years.

The white paper's ambition of creating the "largest and most vibrant social enterprise sector in the world" is a laudable one, but the danger is that it becomes a free-for-all from which the private sector rather than the voluntary sector has most to gain. Voluntary sector and local government leaders are anxious to open a dialogue with GPs on the future of services. Let's hope they want to join in.

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