January 28, 2011

The vandalism of the NHS

Filed under: Uncategorized — madaxeman @ 5:39 pm

Does this really sound like a good idea to you?

The government are currently embarking on a process of changing how the NHS operates, and doing so at a fundamental level. At the moment, when you need a service or some form of medication, the responsibility for it’s provision lies with a body known as the Primary Care Trust. Each NHS trust (effectively a piece of the NHS that looks out for the interests of a defined geographic area) has at least one Primary Care Trust (hereafter referred to as a PCT) – and a large part of the PCT’s day to day operation involves securing the services that the people in an area need – usually from other parts of the NHS such as hospitals etc.

What the government are looking to do however is to do away with the PCTs, and instead have the groups of General Practitioners (family doctors) come together to fulfil this role instead. The thinking it seems is that the GPs are best placed in terms of familiarity with local needs, and therefore ought to be taking the decisions as to how money is allocated themselves.

If you spend ten minutes with a nice warm cup of tea and your thinking cap on, you don’t have to be a genius to realise that this is not exactly a good idea.

GPs already have jobs…

GPs are very highly skilled, trained, responsible people, but they’re also human. They have families, and lives outside of the job – which is a good thing really, because they’d soon burn out otherwise. The point is that they have a limited amount of time to devote to their practices. Given that their time is limited, I think we should be making use of their valuable skills where they can be used to best effect – which is undoubtedly in the consultation room, and not working as purchasing clerks for the health service. Indeed, there is a sound ideological reason what you would not want the person charged with assessing medical need to also be responsible for the allocation of resource to fulfil that need. When you think about it, there’s a conflict of interest there.

If GPs don’t have the time to fulfil this role, who will?

If GPs do not have the time to personally attend to this new “commissioning” role themselves, and yet are charged with the responsibility of it, then there is only one solution open to them – they’ll have to hire administrative staff to attend to it. So, all that will happen is that the backroom activity of the PCTs will move from from the local PCT offices into the GP’s surgeries.

Far from cutting down administration, you’re actually increasing it – as you now have many, smaller groups of administrative staff taking on the role from many different areas. This is poor utilisation of resources.


Basic economics tells us that when you are buying something in bulk, you are better placed to negotiate on the terms of the transaction. As “commissioning” would now be handled by separate “consortia”, we would be losing our bargaining power.


GPs are highly skilled people, but their skills are in the provision of medical care, and not in dealing with the healthcare market. They’re not trained to handle NHS budgets on this scale (the vast majority of the NHS budget), nor do many of them want to.

The costs of reorganisation.

So how much will this reform / reorganisation / vandalism actually cost us then? Well, according to those in the know, you’re looking at over a billion pounds in terms of redundancy costs alone. The government is alleged to expect to be looking at around £400 million in IT and property costs, which will be woefully short of the mark in truth – the government has an appalling record when it comes to estimating the costs of IT projects.

It’s about more that just money though – there’ll be costs in terms of:

  • The loss of experienced staff.
  • The impact of this distraction to GPs on patient care (even though they are unlikely to do the administration themselves, they are still responsible for it, and therefore will have to oversee it regardless…)
  • Morale in the NHS

It’s a crazy scheme – and neither the Conservatives nor the Liberal (ha!) Democrats have a mandate from the people, either generally or specifically, for the changes they are going to try to force on us. It’s time to get motivated people – to fight back. The NHS is one of the few things that our government has historically gotten right – and it’s under attack. Defend it, or you’ll miss it when it’s gone…


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