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As thinktank close to No 10 tells David Cameron to slow pace of reforms, health secretary to update MPs on review of plans to create new GP-led consortia The health secretary, Andrew Lansley, will make a statement to MPs about his plans to abolish primary care trusts amid Downing Street fears that he has failed to explain the thinking behind his reforms. As one of the thinktanks closest to No 10 tells David Cameron to slow the pace of health reforms, the prime minister’s spokesman said Lansley would update MPs on a review of his plans to create new GP-led consortia. “There is a job to be done in convincing people of these reforms … which are the right reforms,” the spokesman said. “As a bill progresses through parliament, parliament expresses a view on that and it can be reviewed.” Asked whether Cameron thought Lansley had succeeded in convincing people of the merits of the health and social care bill – which was first introduced to parliament on 19 January – the spokesman said: “We feel there is more work to do.” Lansley will make his statement as the Policy Exchange, the thinktank most closely associated with the Cameron modernisers in the Tory party, warns that the pace of health reforms should be slowed to ensure that GPs feel comfortable in their new role. He will address MPs at around 4.30pm amid concern that the backlash against his plans is putting years of hard work by Cameron to persuade the electorate that the NHS is safe in Tory hands at risk. Nick Clegg is also nervous about the reforms, which appear to run counter to the pledge in the coalition agreement to “stop the top-down reorganisations of the NHS”. Liberal Democrats voted against the reforms at their recent spring conference. Lansley’s plans would transfer about 60% of the NHS budget to GP commissioning consortia, abolish primary care trusts, appoint an independent NHS commissioning board and extend a regulated market in healthcare provision. Cameron’s spokesman insisted the thrust of the reforms was correct, but added that ministers would use the Easter break to put the bill on hold. The announcement of a delay was agreed at a meeting involving Cameron and cabinet colleagues on Thursday. The spokesman said: “We have got to a certain point in the bill. Committee stage [in the commons] has been completed. There is a break now. “[The health secretary] is going to be setting out the next steps. We have a very clear objective in reforming and modernising the health service. We intend to push ahead with this.” The statement by Lansley follows the Policy Exchange warning that the health and social care bill’s proposals to abolish every primary care trust (PCT) by 2013 “could lead to the new structure simply replicating the existing system in all but name”. The report, entitled Implementing GP Commissioning, is based on interviews with the GP leaders or managers of 16 “pathfinder” consortiums, and with other experts. Its findings will add pressure on Cameron to rethink how he sells the reforms and whether they should go ahead at the pace planned, given the growing hostility from GPs. Some of the Policy Exchange ideas would require radical recasting of commissioning. The study concedes that “the government has lost many potential supporters inside and outside the NHS”, and blames the Department of Health for not winning over GPs. It also questions “whether GPs have the necessary skills to run such highly complex operations before the transition to GP commissioning takes places”. Eve Norridge, the lead author of the report, said: “There are many GPs who have the potential to become highly successful commissioners. It would be a loss to everyone, especially patients, if the policy were discredited due to overly hasty implementation. “Ministers need to address GPs’ concerns before loading such huge new responsibilities on their shoulders. “The danger is that GPs take part so reluctantly in the new scheme that it ends up replicating the existing model rather than becoming the new and innovative system the government desires.” The Department of Health has insisted that applications to join the pathfinder projects show real support for the ideas contained in the bill, but others argue that GPs have merely bowed to what they regard as the inevitable. The interviews suggest: • Not abolishing primary care trusts too quickly. PCTs are struggling to deal with the transition because good staff are increasingly leaving, knowing their organisations are set to be abolished in two years’ time. The subsequent loss of expertise is creating a vacuum that is deterring many GPs from trying new and innovative ideas under the new system. • An end to micromanagement. The authors argue that “many GPs are worried about the size of the new commissioning board and whether a culture of bureaucracy is really ending”. The research found some had been pushed into large groups against their will. Others are “facing pressure to employ ex-PCT staff, regardless of whether they are the best people for the job”. • Bringing commissioning decisions much closer to patients. The report says: “This is one of the key aims of the policy, but it is under threat. GP consortia need to be much smaller than existing PCTs. Current projections for the size of GP consortia mean that commissioning could be no closer to patients than it was in 2002.” • A lack of clarification about the framework and terms under which external support providers might operate. • An absence of trust in the new system. The report says: “It is crucial that patients have absolute trust in their GPs if the new system is going to work. Consortia and their GPs should have to declare any hospitality or gifts they receive from providers of NHS care. “The regulator will need to ensure that information is widely available to mitigate against the conflict of interests between GPs’ roles as providers and commissioners of services.” Health policy Andrew Lansley David Cameron Nick Clegg Liberal-Conservative coalition Health NHS GPs Doctors Nicholas Watt Patrick Wintour guardian.co.uk