But Dixon doubts whether the proposals will be implemented as intended, with many details unclear, consultation yet to take place and negotiations needed with trade unions. Fresh legislation is necessary, which may prove difficult. “Andrew Lansley is said to be a man in a hurry, yet these issues suggest implementation could be slow,” says Dixon.
As with earlier reforms, warns Dixon, the very act of structural change may distract from achieving improvement – made worse by the public finances. “There is a real danger that the financial squeeze on the NHS, which will start to show within 12 months, could derail implementation of the white paper,” she warns. “Many providers will become financially challenged, making their ability to go it alone as a social enterprise organisation difficult if not impossible. And any appetite that does exist among GPs to take on commissioning…. is likely to be dampened by the challenges of having to deliver huge productivity savings.”
Dixon is suggesting that even if the Health bill passes through Parliament unscathed (which in itself is not a sure thing) the time table of changes is too quick, and the finance situation may well mean that trusts will not be able to implement the changes.
Last week I attended a public meeting in Coventry about the White Paper and a local GP said that he thought that the Lansley's policies were "designed to fail".