“Doing nothing is not an option” with the NHS was the oft-repeated phrase by the Prime Minister in the 8.10am R4 Today interview this morning. He is right. There has been unprecedented investment in the NHS and productivity has fallen. Plans devised by Labour to give front-line professionals more power over service design and patient care through ‘Professional Executive Committees’ and ‘Practice-based Commissioning’ were often scuppered by risk averse or obstructive management. Interference and targets from the last government usurped or distorted local priorities or the tenet that the most needy are treated first.The rhetoric of patient choice and accountability had remained illusive on the ground.
Giving greater decision-making powers to GPs over patient care, pathways and access to treatment is absolutely the right thing to do. Enabling greater plurality of care provider is an evidence based way of driving up the quality of care. Streamlining management makes common sense. Critics are wrong in saying that it’s the pace of change that is the problem; there is no point saying we need to change systems and then leaving them for several years to wonder about the future. So what is driving the increasing criticisms from the professional bodies?
No, the devil, as ever is in the detail.
GP’s want to the power to improve care pathways and focus on outcomes; they don’t want to have to run all the management that supports their activity but should have authority over it. As we said before the White Paper came out in July, GP’s focus needs to be on planning and providing improved care. Putting them in charge of access to medicines is also a massively retrograde step; in NICE we have a world leader in evaluating the real value of new medicines. It’s not perfect, it could be improved, but to put that decision in the hands of GPs is opening a Pandora’s postcode lottery box.
Changing the payment mechanism for treatment from a fixed tariff to a variable price over which companies will barter is a disaster. There is no evidence for this improving quality of care, as shown by a recent LSE paper. Prices should remain fixed and providers should compete on quality of care only.
Whilst GPs shouldn’t have to be the management, they should have authority over it. To start over by creating GP Commissioning Consortia instead of simply allowing GP’s to take over the running of Primary Care Trusts is a very long-winded and costly process that will end up in precisely the same place as if GPs had simply been allowed to take over PCTs.
And no it’s not the pace that’s the problem; it’s asking the NHS to find sustainable, efficient savings of £20Bn over four years while so many people will be wondering where their desk is going to be or how their job description is going to change.
Meanwhile the absolute essentials such as the NHS IT infrastructure to enable patient choice and electronic records, real systems of rapid and efficient accountability, adopting telehealth at scale to transform and improve the way care is delivered and seriously reviewing what should be done about unsustainable demand on the NHS is not in the Bill.
Everyone who works in the NHS, the PM, Andrew Lansley and his team all want the same thing: a healthier nation; improved outcomes and more efficient use of tax payers money. Reform is essential; change will happen; amendments to the Health Bill are vital to ensure patients actually receive the improved care that David and Andrew sincerely want them to.