The NHS has to change

The RCGP has written strongly worded letter to Number 10 about the health bill – it’s all over the news today. Some parts of the government plans are welcomed, such as the greater involvement of GPs in buying and planning care. But the RCGP doesn’t like the prospect of more competition – and wants the entire section on competition in the bill to be rewritten.

The trouble is that:

This discussion is becoming about what GPs want –  it should be about what patients need.

We are concerned that there is a danger of creating a climate where it is possible to believe that any change is bad and unnecessary – when actually the NHS fundamentally has to change. And if GPs are to have total budgets, which they want, then they should be more accountable and public should have more choice, which means competition and information. This is what the public needs. We think it’s unacceptable that the public has such little knowledge and choice over their GP – what services they provide, how up-to-date their training is, what improvements they have introduced, what information they provide. Often it’s just the threat of competition that is required for a hospital or service to improve its efficiency and responsiveness – as was shown when ISTCs were introduced. We need the best of both worlds and one can learn from the other.

Another false hypothesis being circulated is that there is a private and public sector battle raging, when in many circumstances they actually work in partnership and have done for decades.

The worry about market failure is not new – but is distracting. In reality the current model not robust. Patients need continuity and as Hinchingbrooke Hospital has shown us, when the public sector fails, the private sector is willing to step in to try to help. There is no inconsistency in having both markets and regulation alongside to ensure universal coverage, guaranteed minimum standards of care and fairness. But of course, unsafe services should be closed.

We all know that monopolies stifle innovation and promote mediocrity in care. We must beware vested interests that oppose competition as they would have to work harder and be more accountable, especially those who spend more time sailing than on their professional development.

Above all we should ensure our focus is on quality of care, not who provides it. And someone needs to be brave enough to admit that WE ARE NOT BEING HONEST. We can’t afford everything – we should be thinking about core services and where people can top-up their care.


About Julia Manning

Julia Manning is a social pioneer, writer, campaigner and commentator. Formerly a clinical optometrist specialising in diabetes and visual impairment, she is the founder and Director of 2020health, an independent, social enterprise Think Tank whose aim is to Make Health Personal and Social. 2020health has through research, events and campaigning influenced opinion and action in fields as diverse as bioethics, alcohol, emerging technologies, fraud, education, consumer technology and vaccination. In 2014, 2020health were founding partners of the Health Tech and You Awards with Axa PPP and the Design Museum. Since 2016, 2020health has increasingly focused on digital health and public health in the community. Julia is a Fellow of the RSA and now also a part-time PhD student at the UCL Interaction Centre, studying the use of digital technology for stress management in the workplace. Julia has shared 2020health's research widely in the media (BBC News, ITV, Channel 5 News, BBC 1′s The Big Questions & Victoria Derbyshire, BBC Radio 4 Today, PM and Woman's Hour, LBC) and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week.
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