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Changing the structure of the NHS will not improve patient care

If you're at all confused about the changes to the NHS being proposed by the government, then read on. 

David Cameron was warned by MPs yesterday that his proposed health service changes would be like ‘tossing a grenade’ under the NHS. The all-party Health Select Committee is uneasy about abolishing the existing Strategic Health Authorities and Primary Care Trusts and handing responsibility for commissioning to GPs.

I hope he listens.

Having worked in the NHS and in New Zealand’s health sector for over 20 years, rearranging structures does not improve health service efficiency. Importantly it does nothing for the quality of care received by patients. This proposal is damaging because: 

  • The 10 SHAs and 151 PCTs which are accountable to the communities they serve are to be replaced by 500 consortiums of GPs. GP practices are businesses. They are not employees of the NHS. They are contracted to the NHS. This is a subtle but important distinction. Who will measure their accountability? A new independent Board. I am interested to understand how? In my time as Chairman of a PCT, it was notoriously difficult to persuade GP practices to give us accurate information about anything and certainly not their finances. They are private businesses.
  • When structures are rearranged for a monolith like the NHS, it takes additional ‘hump’ funding to disentangle the existing structure and establish the new structure. Not only is there no additional funding to support these changes, funding to the NHS is contracting in real terms rather than expanding.
  • Whatever the success or otherwise of the existing structure, a level of expertise has grown amongst existing management together with positive relationships with their communities. It takes time to achieve community links. All that is to be dismantled and replaced by 500 organisations of GPs, a group of experts who inevitably ‘know what’s best for the patient’. How and when will the community be involved in the commissioning process? The treasure chest of community and patient knowledge sitting in PCTs will either walk out the door or there will be a scramble to grab whatever jobs are going in the management groups that will run the consortiums. It’s a nonsense to say that you can run the NHS without a degree of overall management.

Cameron’s proposals have surprised members of his own party, as well as members of the opposition. In a time of economic recession, this will be a foolhardy move. He is asking people to tighten belts, hunker down for an austerity year. The last thing we need is an unsure NHS run by myopic GPs.

This post was written by Penny Young

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