Quote Originally Posted by Rollo
As I understand it, GPs will have to form themselves into consortia to buy and sell health services between levels.
I suppose that this would then make GPs into private practices, as is the case in Australia, with hospitals and other units like pathology, x-ray, etc all separate entities.
GPs are happy because it gives them more immediate control over their own private practices.

In theory it could work, but then there's implications about corporatising and privatising the system later, which is precisely what the Tories want to do.
GP practices have always been privately owned entities which are funded by the NHS. They are owned by some or all of the GPs who work in them (partners) or more recently by private companies that have started to buy entire practices up.

Previously under the Labour government GPs were given a list of hospitals they could refer to for each service they required by their local PCT. The PCT negotiated directly with the hospitals what they would be paid for what service and also assessed which services and hospitals offered the best value for money (amongst other things). Under the new Tory reforms the PCTs will be abolished and the GPs will negotiate directly with hospitals and basically do what the PCTs used to do.

Previously funding would reach the PCTs then flow to the hospitals. Because the GPs had some choice in which hospitals they referred to they would have a virtual budget to play with but no money would actually go through their hands. Now funding will go to GPs which will then flow to the hospitals.

The advantages of the system are that by abolishing PCTs a whole layer of management will be wiped out on paper, however it does not take a genius to realise that since the GPs are already working flat out they will not be taking over the management work the new system requires but will be hiring managers from the PCTs to do the job for them, ie we're talking about moving around the management structure not reducing it.

Some GPs I know (the business minded ones especially) are looking forward to the reforms. Others don't really see why they should be getting involved in the management aspect especially since its something they've never trained for.

While people are concentrating on the privatisation aspect the fact of the matter is that the better run NHS hospitals and those with a bigger brand (ie big city hospitals) will be able to compete with local DGHs for services and win, starving some of the less well run hospitals of business and therefore funding. Its the intra-NHS competition that will cause problems in the long run not NHS/private competition because the inevitable result is that poorly run NHS hospitals will eventually go bankrupt and that is not something either the electorate or politicians are willing to accept.

Its the scale of the reforms that is most worrying however. What I've written above is a simplified version that only touches on subjects you raised. The reforms affect just about every aspect of the NHS and will be implemented quickly, the speed and scale will likely have serious implications that the government and NHS will not be aware of until after the event. That is at a time when NHS funding has been frozen and demand is skyrocketing. Most organisations are looking at making 5-10% savings per year for at least a half decade merely to break even.

Quote Originally Posted by Rollo
I don't think that Cameron's reforms are about making anything better, but rather improving the lot of the friends who fund the Conservative Party through some sort of as yet unseen nepotism and graft.
Which would make them no different to Labour's reforms whereby the inquiry into whether and how private healthcare companies could 'assist' the NHS was lead by people from the private healthcare industry. Many of the first contracts given out to private healthcare providers under the Blair government were generous beyond belief including guaranteed payment regardless of the quantity or quality of service actually delivered. In many cases NHS organisations were simply banned from bidding for contracts including services they already delivered. The Tory reforms set out how private healthcare can compete for NHS services but unlike previous Labour reforms will not subsidise them nor shift the goalposts to help them.

In terms of 'privatising' the NHS this set of reforms doesn't go anywhere near as far as Tony Blair's did. The only recent PM to not be interested in increasing the amount of work given to private companies was Gordon Brown, though he was one of the main architects while he was chancellor.