Tuesday, 5 October 2010

NHS reforms, the iceberg in the water?

I’ve heard it said before that trying to change the NHS is a bit like trying to steer the the Titanic – painfully slow. Well if the NHS is the ship then perhaps the new NHS reforms are the iceberg in the water? The British Medical Association, Unison and Royal College of Nursing have all started warning against the NHS reforms but the government is just going to ignore them.

Before I start my usual ranting I think its worth a bit of an introduction. The last government had tried their best to change the NHS from a doctor-led caring service to a patient demand driven tick-box target-driven nightmare. It was always amusing and perhaps a tad exasperating to hear the previous government talk about 18 week targets and how good everyone was at meeting them. The sad truth is that the numbers were often carefully massaged and manipulated, for example having waiting lists to get on the waiting list. Apparently these waiting lists don’t count for some arcane reason.
Choose and book was created to meet a fictional demand for such a service. Patients can book their own appointments but often referrals vanished into thin air, answerphones switched off (so no messages could be left) and patients called back when they can’t answer the phone (so are booted off the waiting list). All ingenious ways of reaching the mythical 18week target. The worst cases of creative target meeting were A&E departments (too numerous to mention here).
General Practice had a shiny new contract as there was a shortage of doctors becoming GPs. Finally GPs could work sensible hours, could opt out of out-of-hours care (for a pay cut) and would get a pay rise for meeting a variety of targets. Sadly GPs were too efficient met all the targets and they pay soared. The government then waged a bit of a hate campaign against GPs, altered targets, froze pay and forced them to do extended hours again for no extra pay when there wasn’t even a demand for it.
There was also a little thing called Medical Training Application Service (MTAS) – a new way of allocating jobs for junior doctors. Unfortunately it was an umitigated disaster causing a colossal crisis in recruitment and even caused some doctors to leave medicine all together.

And so here we are, a new government and a whole new set of reforms despite telling us at the outset there would be no such reforms. Ho hum. Control of the NHS budget is to be handed to GPs and Primary Care Trusts abolished. Primary Care Trusts previously held the purse strings and could dictate to GPs and hospitals what the money could be spent on.
So now GPs will be in control of multi-million pound budgets. This of-course assumes that they actually want take on this massive responsibility. I stupidly thought that GPs wanted to be doctors who care for their patients rather than be managers. Obviously GPs will have to hire staff to do this complex job so where will they get them from? Well, PCTs will have to make all their staff redundant and give them a hefty redundancy package. These same staff will no doubt be re-hired by GPs to do the jobs they were originally doing. I wonder how much this re-jigging of staff will cost? Not to mention all the re-branding that will be involved!
The government have said that the NHS would be ring-fenced to protect its funding but still want it to find £20bn of savings by 2014 (huh?). So GPs are expected to play a key role in finding these savings by allocating the NHS budget. This means they get the blame rather than the government for cutbacks etc… (clever!). Also GPs won’t see a penny of any savings they might create. More work, no compensation and we’ll get the blame if it goes tits up. Yes please!

I’m going to have a break now. Blogging about the politicians buggering about with the NHS is depressing, tiresome and I’m getting bored (as I’m sure you are also). More ranting after the break. Comments welcome.
p.s. If you want me to post hyperlinks to anything in this blog let me know (I’m lazy)


  1. Good grief - all of it? If they do away with Primary Care Services that covers opthalmic, dental and pharmaceutical services doesn't it? That's a bit of a burden or is it different in England (I'm in Scotland).

    This government seem to be pretty sodden drunk with the idea that people want to run services themselves rather than have good quality services provided. I'm sure I'm not the only parent who shudders at the very idea of running a school.

  2. Thanks - a useful summary for someone from Oz.

  3. There's more to the reforms that restructuring the budget, they are also attempting to privatise the NHS via the backdoor also - I'll explain in my next blog post (eventually)

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