The NHS Reforms

GP consortia

A structure that poses to turn GPs from patients’ advocates and primary healthcare providers into financial commissioners and managers, who are supposed to magically summon new skills that reposition them as budgets balancers.

Market-driven NHS and Stealth Privatisation

Such an approach and open doors to any willing provider,  is slowly transforming the NHS into a business. This has the potential to create a situation where the cheapest provider wins instead of the best provider promoting a ‘scrimp and save‘ approach to patient care.

Local Accountability

This translates to government washing their hands of responsibility of the NHS and the subsequent developments. As such local authorities are likely to vary considerably in their service provision expanding the postcode lottery rather than decreasing it.

In Detail:

The background…

The NHS is a bargain!  We spend about 7-8% of our GDP on healthcare, compared to about 15% in the USA. Yet our life expectancy and child mortality are both better.

Most people are satisfied with the NHS as it is. Last year the Commonwealth Fund surveyed thousands of adults from developed countries about their healthcare system (the countries included were Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the USA and the UK).  In one question, people were asked if they would they be confident that they would get the most effective treatment if they were seriously ill. 92% in the UK said “yes”, the highest out of these countries (this figure was 76% in Canada and 70% in the US).

Some other findings from this survey: in 2010 in the USA, 1/3 of people didn’t get a medication or skipped an appointment because they could not afford it. In the UK this was 5%. In the UK, only 3% of people thought that the healthcare system needs to be “completely rebuilt” – the lowest out of any country. 34% said there should be “fundamental changes” and 62% said that only minor changes are required.

The Government have been using very dodgy stats to talk down the NHS. For example,they said the rate of death from heart disease in the UK is twice that of France. This was true in 2006, but the trend tells a different story: our death rate from MI between 1980 and 2006 fell more than anywhere else in Europe, and is projected to be lower than France by next year.

The changes…

Primary Care Trusts are going to be abolished. Instead, groups of GP practices (“consortia”) will “commission” care – i.e, they will negotiate contracts with hospitals to look after their patients when they need secondary care. This commissioning work is complicated and time consuming…

…and GPs are too busy seeing patients to do it! So many will outsource the job to private healthcare companies looking to make a profit.

For the first time, hospitals will be allowed to compete on price. So, for example, a private hospital could offer to do hip replacements 10% cheaper than the local NHS hospital. The GP consortia will be obliged to consider this offer because of European competition law.

This may seem like a good idea, but there are problems: it is easy to measure how cheap a hip replacement is, but it is much harder to measure quality (problems may not arise for several years). Therefore quality tends to fall when healthcare providers compete on price. Nobody finds healthcare economics good chat, but Ben Goldacre of Bad Science fame has written a readable summary of this topic.


What all this could mean for you and your future patients…

In the short term, there will be less jobs. Partly this is because these massive changes are very expensive (several billion!). Doctors and nurses are already losing their jobs in some parts of the country.

You won’t be working in a “National Health Service”, although the name will probably stay so that everyone feels cosy inside. You’ll be working in a managed market of healthcare providers competing on price – and so there will be pressure to keep your pay down and avoid spending too much on “unprofitable” patients (in practice this means frail, elderly people with multiple problems).

Currently, decisions about whether to fund expensive drugs are made nationally by NICE. Not in the future. The drugs available to your patient will depend on which GP consortia they are registered to. Some may choose to fund expensive new cancer drugs – others may not.

Because they are taking these difficult decisions, GPs will be blamed for “rationing”. This will damage the doctor-patient relationship. Patients won’t know whether their GP is recommending the best treatment or the cheapest treatment.

Medical training will be disrupted. What does a profit-making private hospital get out of giving experience to medical students? The current system relies on good will. But a consultant employed by a private company will be less able to “donate” their time to training the next generation of doctors.

This is only the start. The leaders of the Conservative party have a long term plan to abolish the NHS and replace it with an iinsurance system. This will be unpopular so they plan to do it in stages. Think I’m scaremongering? Here is Oliver Letwin, now David Cameron’s most trusted advisor, writing in 1988:

“One could begin, for example, with the establishment of the NHS as an independent trust, with increased joint ventures between the NHS and the private sector; move on next to the use of “credits” to meet standard charges set by a central NHS funding administration for independently managed hospitals or districts; and only at the last stage create a national health insurance scheme separate from the tax system”

The current changes nicely match “phase 1” of this plan.

Angry about this? Do Something!

For a full copy of the White Paper:

NHS Reforms

4 Responses to The NHS Reforms

  1. abetternhs says:

    I have two leaflets about the reforms to download. One for patients: Kill the Bill and one for health professionals (referenced with details and rebuttals) available here:
    You’re very welcome to copy/use/adapt them yourselves and your readers,

  2. Starlight says:

    Dont forget Education and Training!
    I trained in the NHS and became a GP and I feel the concept of health care free at the point of delivery is a basic human right. I care about the NHS and have seen the costs and inefficiencies of repeated previous organisational reforms and restructuring. There is usually about 12 months while the old organisation closes down, staff leave and decisions are not made. This followed by 12- 18 months as the new organisation recruits ( often the same staff) decides on a strategy, logo, webs site and gets to grips with the issues. So while the folk from PCT and SHA play musical chairs and pop up again in purchasing consortium or skills networks, health care workers continue delivering care on the front line. There have been tremendous improvements in areas such as waiting time s for referral and procedures as well as more patient centred care but I do have concerns. While I shop at a supermarket it is naive to think that I could purchase for all the supermarkets in an area of the South of England. Most GPs want the best case for their patients but do not have the negotiating skills, business skills, time or energy to become procurers of health care. There will be a few who will become GP leaders in this area and it may be a way GPs can influence how care is provided and delivered more effectively but there are risks. The main risk is that the consortium will be no better at this than PCT’s and fragmentation of the NHS with huge impact on education of training. The plans for training of all sorts of health and social care workers seems to be even more fragmented and unclear in Liberating the NHS Developing the Health care workforce which is out for consultation. It suggest that “ skills networks “ may be set up form all the healthcare and education stakeholders. Identifying high quality educational placements, quality assuring them, developing staff in educational roles supporting learners, providing education al facilities ,libraries, IT, skills labs etc are all vital components in the pipeline of human resource management. Education is often forgotten. When digital X rays were introduced across the NHS no one considered the needs of students on placement (medical students, Physio students and nursing students) to be able to be trained or access the images. We have very good opportunities for people to be trained and developed in new and traditional roles but much of that is dependent on the culture and environment of the organisations and this is just the area that is coming under so much pressure.

  3. Tim Smith says:

    Sir David Nicholson (chief exec NHS) seems to have admitted today that reforms are likely to mean hospitals/health service will have to change the way it works. I can’t find the orginal article but here’s the BBC report on it…

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