Saturday, 5 February 2011
NHS Reform
Since August, I have been talking to local partners about the forthcoming NHS reforms. Over the last week I have had a series of useful meetings. First, I met with Surrey County Council to hear more about their plans to take on responsibility for 'public health' from the Primary Care Trust (PCT). This is a vital area of health policy, which involves disseminating information and promoting public awareness of important health issues - from leading healthier lifestyles, to preventing illness. In our consultations, I made it clear that this should not be a pretext for an extension of the 'nanny state'. Rather, policy will be subject to direct local democratic control, which means local health priorities set by those accountable to the community.
I have also been meeting with local GPs - from Molesey to Oxshott - to hear their views on 'GP commissioning', the plan to give consortia of local doctors the authority and responsibility to commission local health care priorities for their patients and local communities. Yesterday evening, I spoke to the Friends of Capelfield Surgery and listened to what local GPs and residents had to say.
The fundamental principle is that local GPs are better placed than the faceless and unaccountable bureaucracy of PCTs to set local health care priorities. There are a range of practical questions that the GPs have in relation to implementation - especially the responsibilities they will take on - but many were enthusiastic about the changes. The bottom line is that the PCT has been seriously mismanaged. But, not for lack of managers! In fact, there is far too much wasteful bureaucracy. In Surrey, the PCT has racked up an incredible £125million deficit.
Of course, the GPs may need bespoke support - from legal to business advice - but it ought to be more cost-effective for them to hire that in as they need it, rather than continuing with the current expensive and inefficient PCT structure. The new consortia won't be set up until April 2012. In the meantime, I look forward to continuing the dialogue with local doctors and residents, to help them facilitate the implementation of these plans.
I have also been meeting with local GPs - from Molesey to Oxshott - to hear their views on 'GP commissioning', the plan to give consortia of local doctors the authority and responsibility to commission local health care priorities for their patients and local communities. Yesterday evening, I spoke to the Friends of Capelfield Surgery and listened to what local GPs and residents had to say.
The fundamental principle is that local GPs are better placed than the faceless and unaccountable bureaucracy of PCTs to set local health care priorities. There are a range of practical questions that the GPs have in relation to implementation - especially the responsibilities they will take on - but many were enthusiastic about the changes. The bottom line is that the PCT has been seriously mismanaged. But, not for lack of managers! In fact, there is far too much wasteful bureaucracy. In Surrey, the PCT has racked up an incredible £125million deficit.
Of course, the GPs may need bespoke support - from legal to business advice - but it ought to be more cost-effective for them to hire that in as they need it, rather than continuing with the current expensive and inefficient PCT structure. The new consortia won't be set up until April 2012. In the meantime, I look forward to continuing the dialogue with local doctors and residents, to help them facilitate the implementation of these plans.
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4 comments:
Dear Dominic,
GP Commissioning, will subject GP's to competition law and they will have to manage a competative tendering process. Poviders from NHS Hospitals, other GP practices, private clinics and voluntary health providers, will all be able to place bids to provide services. This is likely to require considerable administrative support. There will also be a need for GP's to monitor outcomes for patients, to ensure services are up to standard, increasing the administrative burden.
By having lots of small GP consortiums purchasing services, there is a danger that paper work could be duplicated and even less cost affective than the current PCT commissioning model.
Lord Green pointed out in his review of services, that government departments that purchased in bulk, in the main, paid less for services and products. Fragmenting the NHS in this way could cost more in the long run and impact on patient care.
The PCT also provide a very important role in setting up and monitoring joint care protocols between GP's and Secondary Care Providers. These ensure good care and monitoring of patients who take drugs classified as Amber such as immunosuppresant medication, used to treat people with some types of caner and autoimmune disorders such as Crohn's and Ulcerative Collitus. Who will take on this role in the absence of the PCT?
Can you explain in more detail, how you feel GP commissioning will be less expensive than Primary Care Trust Commissioning?
Many thanks
Emma Rogan
The PCT has £125mn deficit, which highlights the mismanagement. Getting rid of the PCTs will cut down on the excessive bureaucracy and (in my view) excessive numbers of over-paid managers, channeling more money to the frontline medical professionals.
One of the major local concerns I hear is the way the PCT has salami-sliced our community hospitals. There will be scope for local GP consortia to work in partnership with the community hospitals, recognising the value patients place on proximity of their services and tailoring their services to local need. Doctors and patients will have greater control over setting local healthcare priorities.
There will only be scope for local GP consortia to work in partnership with the community hospitals if the community hospitals have submitted the lowest bid in the tendering process.
Given that large multi-national healthcare organisations are salivating in the wings to get their hands on our NHS, they are very likely to undercut all the local hospital bids, and so be awarded the contracts. And if they don't get the contracts, they will sue the GP consortia for anti-competitive behaviour under European hospitals.
So bye bye local hospitals.
I don't accept that analysis. Community hospitals have a unique position in our community, as local hubs, and GP consortia are well placed to take advantage of it. Nor is the competition law position as you describe - I started my career, training as a competition lawyer.
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