Published: January 25th 2011 - at 8:00 amHow the Tories unleased chaos in the NHS
I am a GP who has been involved in an evolving commissioning consortium (‘pathfinder’ no less), to try to make some sense of the government’s ‘reforms’. Although the Bill has just been released, since the bombshell was dropped with the White Paper in July people have been busy.
Most GPs in our area can be divided into two categories; those who think the plans are bonkers and don’t want to waste any time on it, and then those who think the plans are bonkers but want to limit the damage.
I belong to the second category and I think there is a general view amongst GPs that we are at least a little responsible for the NHS, which most of us are proud of. That, unfortunately, means that when something as massively potentially disruptive to our patients comes along, we cannot ignore it. This shouldn’t be confused with consenting to the changes.
There are a number of changes potentially damaging to the NHS, increased privatisation, destabilising hospitals, price competition, geographic variation in services and quality etc. However, there are more pressing problems that are happening now and are likely to accelerate.
Put bluntly, there is a developing meltdown in the administration of the NHS. As soon as the White Paper came out in July, the whistle was blown to start a period of nearly 3 years of instability and waste in the NHS. This has been made worse by recent policy adjustments. What is happening is that a crucial (and unseen) part of the NHS – the PCT commissioning and administration functions have been well and truly hamstrung.
Where I work, the local Primary Care Trust is generally well respected and does a good job trying to hold down costs at a local large hospital (not an unusual situation). Also, whisper it, but the financial instability had been quiet for a few years now.
Since July, staff have been distracted by the huge elephant in the room – that at least 40% of them will lose their jobs soon, and likely all by 2013. This matters in that if they take their eye off the ball, costs escalate and quality targets deteriorate. Then it is the patient who suffers.
Not only this, once key managers start leaving or being head hunted, key local and institutional knowledge is lost and will take some time to replace. For example, a finance officer who has for years successfully rehearsed arguments with the hospital about how much of a discount the PCT should get, goes, it will take months to pick it up. During this time the budget could be millions over.
It gets worse. Locally, where I work, GPs have sensibly decided to try to preserve the local infrastructure as much as possible and move quickly to set up a consortia to try to keep the managers who know how to do the job. However, PCTs staff are now being centralised in ‘clusters’ of 3 or so PCTs. This robs GP Consortia of local talent. GP consortia also have no way of employing the PCT managers so the uncertainty worsens.
This all leads me to conclude that a large part of the agenda of the government must be to literally destroy the managerial expertise and infrastructure of the NHS. This means that GPs will have no-one else to turn to but the private sector, who will have little local knowledge and an entirely different agenda. The alternative is that the Tories do not understand the importance of NHS managers, which may also be true.
Why does it matter? Well, unleashing chaos within an organisation that can be as fragile as the NHS will without doubt cost lots of money and sadly will lead to, as usual, the most vulnerable and voiceless patients losing out.
The sad thing is that it didn’t have to be like this. Bringing in GP leadership to commissioning and health service planning was perfectly sensible and possible. However, if it had been done within the existing infrastructure the risk lower, the cost less, and the potential damage averted.
So lets nail the lie that ‘there is no alternative’. The NHS was not broken so it didn’t need a radical overhaul, just sensible progression of renewal reflecting its values.
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Story Filed Under: Blog ,Fight the cuts ,Health
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Reader comments
Good post and really good to hear from someone involved at front line organising and provision.
This is a good posting. Where I live Kent, Sussex & Surrey PCTs are set to lose 700 jobs. There are 72 internal vacancies. These people aren’t cleaners, they have significant roles within the NHS. Do we suddenly no longer need their expertise? What will the consequences be?
Doing away with the internal market would have saved money and reduced admin, but it doesn’t fit with the ruling ideology.
Well, I’d say we prepare for a new and huge raft of overpriced management consultants, who take up the slack left by lost staff and look to cut services, rather than drive down costs.
This article begs the question how destructive and far reaching do Lansley’s ‘health reforms’ have to be before staff in the NHS finally get off their arse to provide some kind of resistance to them?
We can all see where this is going, yet it is my impression that most factions are simply jockying for position rather than objecting to the key principle driving this reconfiguration, namely to create the sort of conditions that enable private health giants to secure a sizable portion of the NHS pie?
We are fast approaching a point where staff must decide if they are part of the problem, or part of the solution, because, by and large, the general public have been hoodwinked as to the true nature of these changes, and by the time they want to do something about it – it may well be too late?
By the way, “GPs will be legally bound to adhere to all of their consortium’s commissioning decisions, including policies on referral management and prescribing, under plans laid out in the Government’s health bill. If the bill is passed, each practice will be legally obliged to become a member of a consortium from April 2013, and will be required to act in accordance with the group’s commissioning policies”.
http://www.pulsetoday.co.uk/story.asp?sectioncode=35&storycode=4128310&c=2
For ‘consortia’ read, Aetna (US); Axa PPP (UK); BUPA (UK); CHKS (UK); Dr Foster (UK); Health DialogServices Corporation (US); Humana (US); KPMG LLP (US); McKesson (US); McKinsey (US); Navigant Consulting (US);Tribal (UK); UnitedHealth Europe (US); and WG Consulting (UK) – at least if not today, then tomorrow?
It’s never a good time to fall sick but NHS healthcare prospects for the next several years look especially bleak.
Worth reflecting on the latest proposal for “enhancing” the dispensing of NHS healthcare: From the health service that introduced NHS Direct call centres comes the latest ruse to prevent the sick from visiting their local GP: diagnosis by email.
http://www.dailymail.co.uk/debate/article-1349935/NHS-reform-GPs-diagnosis-email-deadly-gamble.html?ito=feeds-newsxml
Compare: “Up to 12 million working UK adults have the literacy skills expected of a primary school child, the Public Accounts Committee says. . . The report says there are up 12 million people holding down jobs with literacy skills and up to 16 million with numeracy skills at the level expected of children leaving primary school.”
http://news.bbc.co.uk/1/hi/education/4642396.stm
In 2010, 30.1 million adults in the UK (60 per cent) accessed the Internet every day or almost every day. This is nearly double the estimate in 2006 of 16.5 million. The number of adults who had NEVER accessed the Internet in 2010 decreased to 9.2 million, from 10.2 million in 2009.
http://www.statistics.gov.uk/cci/nugget.asp?id=8
A good post.
When the White paper was published GPs were worried that they would have to inherit the debts of PCTs. In spite of Cameron’s “won’t cut the NHS” rhetoric, PCTs have been cut. The Operating Framework (the NHS rule book for the next financial year) has the figures: (section 5.12) average PCT increase is 3% but (section 5.6) says that 2% of PCT funds will be held back by SHAs to pay for Lansley’s vanity re-organisation. Inflation is more than 3%, so that is not the “real terms rise” we were promised. Couple that with the 2% withhold that should be spent on treatments but is being spent on the unnecessary re-organisation and you can see that PCTs have a funding problem from April this year. Then add in the debts that PCTs already have with things like PFI and you can see why GPs were worried.
In an attempt to address this issue Lansley came up with a kind of compromise. The Operating Framework (5.10) says, effectively, that PCT debts will be written off prior to April this year (where this money will come from, no one knows, I suspect PCTs will sell off a lot of property in the next few months), but GP consortia will be responsible for PCT debts generated between April 2011 and April 2013 when the PCTs will be abolished. Thus GPs have a real reason to become a pathfinder and start rationing healthcare. If they don’t, they risk inheriting a debt generated by the PCT which (as the OP mentions) is in meltdown and cannot perform properly. When the OP says “those who think the plans are bonkers but want to limit the damage”, the damage is the large debts that will accrue from PCTs trying to give the treatments that people need when funding is being cut by a Conservative government who wants you to pay for private care.
http://torylies.blogspot.com/2011/01/enthusiastic-or-bullied-pathfinders.html
I think Cherub, (above) may not be helping their point by saying “These people aren’t cleaners, they have significant roles within the NHS” . I think cleaners have a very significant role in the NHS, and the sacking and privatisation of cleaners (masterminded by Lord Ashcroft, as it happens) is one of the Tories worst contributions to the NHS to this point.
Many thanks, Guest – and also Richard at [7].
I have a meeting of my local GP practice’s Patients Support Group to-night, is there anything else I ought to know?
This is no surprise. The tories by nature are cowardly individuals. They are greedy and give not a toss for anyone else. They hate the NHS, they voted against it and have tried to run it down ever since. But they know that if the came out and told the truth they would not get elected.
So they lie, and pretend that the love the NHS while all the time trying to dismantle it. Divide and rule has always been the tory way. Turn doctor against doctor, teacher against teacher and so on. “Look over there a royal wedding” while we tear your health service down.
@Mike [9] you should ask the GPs how they will be able to influence the commissioning (or rationing) decisions that their consortium is likely to make. Also ask if there are any plans to outsource the commissioning support to private firms and ask them not to if they are.
(I’m answering as post author btw).
I am a GP and I totally agree.
[11][12] Joe, Nancy – I guess what you guys want to do is medicine – there are a few GPs who are entrepreneurs first and medics second, but they probably don’t visit this site. Do you really want to manage administrators and allocate resources?
No, I didn’t think so. And when one of the companies mentioned in [5] offers you money to do it for you, how long will you mutilate yourselves on the altar of your principles? (To say nothing of the two years’ debts the government is going to dump on you – see [7] above.)
The destruction of the NHS will be Cameron’s proudest moment.
14 Yup.
And a lot od the poor suckers who voted for him don’t know that yet.
Secret footage has just emerged of Cameron discussing the coalition’s health reforms with Clegg!
http://www.youtube.com/watch?v=Kc8fqgbU_SU
I am worried all the effort been put over the years in NHS to creat a very good system will be lost 
Reactions: Twitter, blogs
- Liberal Conspiracy
How the Tories unleased chaos in the NHS http://bit.ly/f1Tm8a
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This is good and from the frontline: a GP's view of proposed PCT cuts and NHS changes: http://bit.ly/ibtOGE
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RT @hangbitch: This is good and from the frontline: a GP's view of proposed PCT cuts and NHS changes: http://bit.ly/ibtOGE
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RT @hangbitch: This is good and from the frontline: a GP's view of proposed PCT cuts and NHS changes: http://bit.ly/ibtOGE
- Rachael
NHS was not broken it didn’t need a radical overhaul just sensible progression of renewal reflecting its values. http://t.co/jnTu1Se @libcon
- Rachael
NHS was not broken it didn’t need a radical overhaul just sensible progression of renewal reflecting its values. http://t.co/jnTu1Se @libcon
- April-Rose
RT @hangbitch: This is good and from the frontline: a GP's view of proposed PCT cuts and NHS changes: http://bit.ly/ibtOGE
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RT @hangbitch: This is good and from the frontline: a GP's view of proposed PCT cuts and NHS changes: http://bit.ly/ibtOGE
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RT @libcon: How the Tories unleased chaos in the NHS http://bit.ly/f1Tm8a
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A GP explains how the coalition are creating instability and waste in the #nhs and why they're doing it http://t.co/wGZnZ8g via @libcon
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How the Tories unleased chaos in the NHS | Liberal Conspiracy http://goo.gl/APZ2L
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