Proposals for a major shake-up of the NHS in England were revealed by the coalition government last week.
A white paper announced by health secretary Andrew Lansley aims to introduce a national independent NHS Commissioning Board to commission services such as primary ophthalmic provision.
Responsibility for spending the budget and the implementation of services will lie largely with GPs, which will see the 152 primary care trusts (PCTs) being phased out. The scheme will be piloted throughout next year by GPs with a full roll-out in 2012.
The changes have been largely welcomed by the optical profession. A spokesperson for the College of Optometrists and the Optical Confederation stated: 'Being a national service, set out in regulations, regulated by the GOC and market-led, the funding genuinely follows the patient and the system delivers accessible care without waiting, wherever patients want it, the length and breadth of the country.'
The British Medical Association said it was 'ready, willing and able' to implement the changes. However, there has been criticism of the introduction of such a sweeping change at a time when the NHS is already under pressure to cut costs and the potential for mass adoption of private sector run schemes with priorities that may differ from a desire to improve services.
Optician clinical editor Bill Harvey commented that anything that resulted in a more unified national strategy was to be welcomed. 'While PCTs have had responsibility for launching strategies for modified referral, low vision provision, health screening and so on, the difference in each PCT's priorities has resulted in a very fragmented service in England,' he said.
'While Scotland and Wales have made great strides in optometric involvement in eye care, England has been left with an uncoordinated mess of variable quality. There is a potential cloud on the horizon. GP-run consortia, assuming enough GPs feel in a position to assume this extra role (not all did when they were made responsible for local budgets in the 1990s), will feel duty bound to adopt efficiency driven schemes. Indeed the model set out by Lansley makes it clear that the GP-run consortia are effectively independent businesses operating outside the NHS.
'Efficient schemes may well be presented by private companies and this may run the risk of an overall erosion of national health services. Should the private sector be allowed to run frontline services, such as low vision schemes, social services or children's services?
'The recession makes cuts inevitable but let us hope the need for greater efficiency does not evolve into the erosion of services altogether if viewed expensive and expendable.'
An analysis of the potential impact of the white paper will appear in future weeks. Please email your thoughts to the clinical editor (william.harvey@rbi.co.uk).