The Plans The Coalition Government maintain that their plans for the NHS will provide greater choice and voice for patients, give power to the clinical professionals working in the NHS (as opposed to managers) and drive up standards producing better outcomes for all concerned. Whilst protecting front-line services, management costs are to be reduced by 45% over the next four years.  Most people would not disagree with these aspirations, least of all clinical professionals working in the NHS. However, many have questioned the need to make sweeping changes to the NHS to achieve these objectives. However, in practice, these proposals are highly unlikely to achieve these objectives for the following reasons: GP Consortia will be responsible for buying health care for the population of England with £70 billion. Given that most GPs do not have the skills/knowledge to commission, how will they be able to do this? They will clearly need to employ people to do this for them. Some of these managers may well have previously worked for Primary Care Trusts and Strategic Health Authorities. A number of these are likely to have benefited from substantial redundancy payments funded by the tax-payer. Private organisations are likely to compete for lucrative contracts - both in commissioning and providing services. GPs are largely self-employed business people. They are likely to expect substantial financial incentives to participate in commissioning on such a large scale. Standards can only be driven up if commissioners have an in-depth knowledge of the clinical areas for which they are intending to buy services - this is unlikely to be the case, at least for some considerable time.  With local variations in commissioning practices, patient choice and voice may be improved for some but many are likely to remain just as marginalised as they have ever been. As Primary Care Trusts can no longer provide services after next April, there will be significant logistical upheaval for the staff having to move into other NHS or non-NHS organisations. Many staff still do not know whether and who they will be employed next April. The Royal College of Nursing is not confident that front-line services will not be cut, as recent press reports seem to confirm. Health care/support staff morale is likely to plummet - having to cope with the stresses of an unnecessary re-organisation, a two year pay freeze for those earning above £21,000 and future uncertaintly about protection of terms, conditions and pensions. In short, this is a NHS re-organisation which is going to be highly expensive, cause considerable upheaval and stress to the majority of NHS staff. Jobs and crucial NHS expertise will be lost, perhaps for good. Non-NHS organisations will be free to tender for lucrative contracts from GP Consortia raising questions about whether appropriate safeguards for transparency and accountability are in place that later prove to be robust enough. Privatisation, whether by stealth or otherwise, is on the cards. All of this under the guise of increased patient and front-line clinical staff empowerment and choice - that has little chance of ever becoming a reality. Remember also, that the Coalition partners misled the electorate during the election campaign over their plans for the NHS! The next section outlines some of the ways that you will be able to do this.

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