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Page last updated at 10:05 GMT, Monday, 5 September 2011 11:05 UK
Businessman Sir Gerry Robinson fears 'end of the NHS'

Sir Gerry Robinson watches CT scan in Harley Street
Some PCTs have already began to close

As the coalition government plans the biggest shake up in the 63-year history of the NHS, businessman and corporate troubleshooter Sir Gerry Robinson offers his viewpoint after spending six months taking the NHS's pulse.

Are the government's health reforms a step forward - or a step towards the eventual dismantling of the NHS?

The core reform will see the end of the Primary Care Trusts (PCTs) which currently decide where NHS money is spent.

PCTs are to be replaced by GP led Clinical Commissioning Groups which will make decisions about patient care and whether the public NHS or private care services best meet those needs.

The government has came under sharp criticism over these proposals - which led to a "listening exercise" around its plans.

I have been doing my own listening, meeting the people who would have to make the changes work - our GPs. And I have come away with grave concerns over the very future of our beloved health service.

Patient choice

A key part of the new reforms is offering patients a choice between NHS and private care. But at a GP practice in Hackney, east London, Dr Deborah Colvin told me she is worried that this could unravel schemes like her diabetes project.

"If a patient said, 'I want to see a diabetic nurse from that company and a dietician from this company,' it is going to make my life a nightmare in terms of different payment systems, different forms.

"I would never get everybody together to talk together and that would not be best for patients," said Dr Colvin.

She is proud of the scheme she devised for local diabetic patients that brings a number of local agencies into the practice to deal with this complex illness.

Andrew Lansley (l) and Sir Gerry Robinson
The government wants GPs to take on more responsibility

What worries me, and what I do not think will work in the long run is to use outside providers because they appear cheaper in the short term - but that are not part of a properly managed, strategically planned system of care.

I think there is a place for outside providers but it needs to be very carefully managed.

When I met Health Secretary Andrew Lansley, he defended the reforms but acknowledged that patients need to know what is being proposed.

"You have got 50 million patients for whom it [the NHS] is always going to be important, so when they hear that the service is going to be fragmented, is it going to be safe in the future, they need to know it is going to be safe."

Better kit

Despite criticism of Mr Lansley's plans, I also found grassroots support for wholesale change.

The changes are better for patients and better for NHS finances according to Dr Kosta Manis, a GP in Bexley. And key to that is the central reform - giving GPs substantial control over budgets instead of the current PCTs.

And that means control over how much they pay for services from the NHS and how much they buy in from the private sector.

In the past, Dr Manis referred patients with heart complaints to a local hospital where consultants usually ordered an often painful and expensive angiogram, using a catheter to probe inside the coronary arteries.

Dr Manis has found a more effective and cheaper alternative, which makes invasive angiograms unnecessary.

Patients at Dr Manis's surgery are examined on the spot to decide whether tests are needed by a top cardiologist, Dr David Brennand-Roper, brought in from a London teaching hospital.

If Dr Manis's patients require further tests, they are sent to a private Harley Street clinic equipped with a high-tech CT scan.

"When they analysed the costs of sending a patient to the chest clinic versus the cost of a journey through a hospital including various tests they could save £1,000 a patient at the clinic," Dr Brennand-Roper told me.

Sir Gerry Robinson watches demo

Gerry Robinson presents Panorama: Gerry and the GPs

BBC One, Monday, 5 September at 8.30pm

This is an example where NHS money is being spent on a private provider - simply because they have got better kit.

I agree with saving the money where possible, but I really do wonder why we cannot have similar facilities to that Harley Street clinic within the NHS - especially if it presents cost savings.

Dr Manis was also concerned that angiograms were often routinely ordered at the local hospital because they were a source of income for the NHS hospital, not because they were absolutely necessary.

The South London Healthcare Trust denied the allegation that unnecessary angiograms were carried out and said it was working closely with local GPs to improve services.

Hospital closures

The health secretary agreed that the current system can encourage waste.

"It happens because of the way the payment system in the NHS works at the moment - because it pays for activity. So of course if you incentivise somebody just to do more work, they will do more work," Mr Lansley said.

This naturally provides great potential for waste if hospitals are not vigorous in weeding out unnecessary procedures.

I also have concerns that GP reforms would affect other elements of the NHS, possibly even leading to hospital closures if hospital incomes are significantly reduced as money is spent instead on private health care.

"If the people who are commissioning the services want the services to be there, if the public want the service to be there, if it is transparent that the service is in demand it does not actually make sense just to shut it down," Mr Lansley said.

Make no mistake, I am a firm believer in the need for NHS reform in the face of increasing demand and an aging population - and I support the involvement of GPs in the budgeting process. Still, I am left with serious doubts about key elements of the plans as they stand.

I think the stakes here are huge. Who is going to be managing that big picture?

Unless somebody really does grab this thing at the centre and has the courage to make unpopular but right decisions then I fear this could spell the end of the NHS.

Panorama: Gerry and the GPs, BBC One, Monday, 5 September at 20:30 BST and then available in the UK on the BBC iPlayer .

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