Now half-term is over

It’s back to work today for all the GPs returning from the ski-slopes and MPs coming back to more Bills than a flock of pelicans. DH has been fairly quiet, just commenting on food and drink: Lancet claims that Ministers are too close to the alcohol industry and Loyd Grosman complains that NHS food is still poor. Difficult when, for too many politicians and health professionals, alcohol and chips remain the first resort for comfort. But a quick look at this graph shows just how poorly the UK has done in comparison to other countries.

Credit: Lancet and WHO European Health for All database. http://data.euro.who.int/hfadb.

However while it may have been because DH was on half-term too, the quieter week was also because they needed to allow time for David Nicholson’s latest letter to sink in. It feels like having been dropped in the deep-end in July, successive missives are moving GP Commissioners into shallower waters, giving them reassurances and frameworks that while welcomed by some, actually the most ardent advocates will not want as it restricts their freedoms. A key section of this letter says:

“So while consortia will have the freedom to shape services and drive improvements locally, they will do so within a national framework and with support and guidance from the NHS commissioning board. This will mean creating an integrated system between consortia and the board, which supports the delivery of national accountabilities as well as local priorities.”

The challenge will be for the centre to allow as much freedom as possible while ensuring accountability. And there remain other nagging questions too following what he also says in his letter,

“…means moving from a system configured to diagnose and treat, to one configured to predict and prevent. And it means driving the improvements in clinical care that will have the greatest impact on improving quality and value, particularly by transforming the management of long-term conditions, moving services closer to patients, and containing demand for urgent care.”

Moving From: a system designed to put prevention & prediction at its heart is fine – but the treatment has to go on even if you are hoping to treat fewer patients – they are not an either /or. Question: are there any time/ capacity predictions for this new “both-and” system to help consortia plan?

Moving services closer to patients: absolutely if we are talking about Telehealth; absolutely not if we are talking about acute and specialist care! Question: Hospitals will be more remote for most of us in the future and won’t repetition of “care closer to home” be giving the public a singularly wrong impression?

Demand: we are still not having frank conversations about what controlling demand means. So far there’s been too much trying to find ways of shutting the stable door after the horse has bolted. Question: If we don’t address prevention of demand (e.g. consequences for poor choices; explaining risk-displacement; understanding that every individual health choice has an impact on the whole of society and that we can’t honestly deliver everything the NHS Constitution promises) aren’t we putting our health professionals into an invidious position?

We’re really encouraged by the enthusiasm and ideas of many of the GPs we are in touch with – but their commitment and support needs to be retained by an ongoing narrative from the centre that communicates trust, assistance and answers to those nagging questions.