'Neither competition nor commissioning reform alone' can be relied upon to make the improvements needed to save the NHS from 'treacherous waters' ahead, according to a report from independent health charity The King's Fund.
NHS reforms are underpinned by the government's approach to driving performance; moving away from targets and performance management toward a focus on outcomes, transparency of data, greater control for local clinicians, and increased choice and competition.
But the report Health policy under the coalition government: a mid-term assessment published as Independent Nurse was going to press, suggests these policy levers will not be effective in supporting patients in the home or the community.
It says the NHS is entering a period of significant risk, which could jeopardise progress made over the past decade. As unprecedented financial pressures start to bite, cracks are beginning to appear, while major organisational changes and the loss of experienced managers, has left the service in a precarious position.
Anna Dixon, director of policy at The King's Fund, said the findings prove the NHS needs to 'do more' in the area of primary care.
She said: 'Long-term conditions are included in the NHS outcome framework, but patients with multi-morbidity need to come more into the primary care focus. Clinical commissioning groups will have to understand local data and make improvements. But we shouldn't expect them to be able to do this soon.
'With NHS savings continuing and a pay freeze the productivity challenge is great and nurses will have new responsibilities and maybe too much work.
'Neither competition nor commissioning reform alone can be relied on to make the improvements needed. Fundamental change will be required to address the challenges of the future as the population ages and health needs change.'
Howard Catton, policy director at the RCN said: 'Pay freezes have delivered efficiencies but this is not an efficient or sustainable strategy. It will have a negative impact on recruitment. The report reveals a demoralised workforce doesn't deliver quality care. The Kings Fund has exposed that savings cannot be made by pay freezes or job cuts.'