Keep Our NHS Public was started in 2005 because the three founding organisations were so concerned about the creation of a market within the NHS. The current proposals if passed would:

• Transfer the responsibility for the NHS from the Secretary of State for Health to a new NHS Commissioning Board
• Abolish Strategic Health Authorities (SHAs) responsible for planning services for a region and monitoring Primary Care Trusts PCTs.
• Abolish PCTs who are given government (i.e. taxpayers') money to purchase services for patients from hospitals (trusts) and other care organisations and pay for general practitioners (GPs).
• Create 500-600 groups of GPs called consortia which would take on the commissioning (purchasing) of services. They would replace 152 PCTs.
• Force all hospitals to become Foundation Trusts (FTs) and encourage them to become employee led social enterprises.
• Encourage 'any willing provider'
• Increase the powers of Monitor (who oversees FTs) who 'will become an economic regulator, to promote effective and efficient providers of health and care, to promote competition, regulate prices and safeguard the continuity of services'.
• Reduce NHS management costs by 45% over the next 4 years.

The language is reassuring and some doctors think they would do a better job commissioning services than their local PCTs, many of whom have been unaccountable and uncommunicative. It is all about patient choice, putting power in the hands of the clinicians and improving outcomes.

The private sector was hardly mentioned by the Secretary of State for Health when he gave evidence to the Health Select Committee in July. He aims to create 'the largest social enterprise sector in the world' yet again imposing an untried system on the whole NHS as was done in 1974 (consensus management in DHAs), 1984 (Griffiths general management) and 1989 (Kenneth Clarke's internal market and introduction of the purchaser/provider split).

GPs are not trained to do commissioning and will have to use managers either displaced from the NHS or from private organisations. The BMA Council has elected to take part in 'constructive engagement' with the government but grassroots doctors are unhappy, particularly hospital consultants whose expertise has been ignored.