2 min read

Editor’s blog Friday 11 June 2010: The good, the bad and the pointless from the SMF

In the new report, Axing And Taxing by the Social Market Foundation, there are three new ideas of varying quality.

The good ...
Their good idea is that public sector workers should contribute and extra 1% of salary into pension contributions. It would be reasonable to see further incremental contributions over a long timescale, but this is a sensible start on a massive problem for future generations.

... the bad ...
he bad idea (and it is a very bad one, but not new from the SMF) is a £20 charge for GP appointments. The overwhelming balance of evidence and informed opinion is that the NHS's probalems are very little to do with inappropriate usage of GP services, which are remarkably cheap, even allowing the average GP earning rising from £44,000 in 1997 to over £100,000 today.

They cite Germany having reduced demand for primary care in this way: it did, but researchers have found that those most deterred from using primary care were (unsurprisingly) the poorest). Gericke and colleagues (2009), writing in the Journal of Management and Marketing in Healthcare (COI dec. - I'm on its editorial board) last November showed that this cost-sharing has not improved allocative efficiency or equity, merely shifted costs.

The effects were more fully discussed in this write-up of an NHS Confed policy salon, which discussed a previous SMF document proposing this change.

This event heard that "Research data on the German experiment found that 27% of those surveyed reported having delayed a GP visit; 18% avoided one; 25% made an additional visit (in the German approach, one payment makes GP visits free for a quarter of the year); and 30% reported no change to their behaviour. 20% of over-60s reported having avoided or delayed a visit. The poorest avoided visits most, 2/3 of poorest reporting having done so."

... and the pointless
Pay is also the locus of their pointless idea: a 10% cut in GP and consultant earnings, then to be frozen for five years. Singling out GPs and consultants for cuts is unwise, given that many managers and nurses earn similar salary levels (but have less potential for private or additional earnings). It is also unwise given the need for clinical engagement in the next stage of NHS reform.

The big money is saved by cutting everybody's pay in the NHS, by graduated amounts so the lower earners have lower cuts (or none at all below £20,000, as Alan Maynard has suggested).

Harder to do, but better to achieve, would be some small linkage of pay (but major recognition and judos) with improved outcomes.