Professor Alan Maynard OBE looks at the emerging elements and wicked issues from the current policy fog
The English NHS is scheduled to have its most significant “redisorganisation” since the 1970s. As ever, it is well-intentioned but largely evidence-free.
Furthermore, the details of the changes are lacking - and HM Treasury is currently very worried about ensuring that GPs are accountable. The idea of GP accountability is a nice issue, as primary care has largely been a data-free black hole since 1911.
You say you want a revolution …
So is the intention after 100 years to make GPs accountable? The notion seems to be to force all these “workers” into 500 gulags or consortia, and make them responsible for purchasing billions of pounds of healthcare provision.
Obliging the GP comrades to reorganise in this way will be a nice political challenge, requiring many a nice bribe no doubt! But surely 500 is too many?
… don’t you know that you can count me out – in!
Secondly, what data are to be collected to inform this revolution?
The new Government is emphasising the need for better information. Good! But what new data is prioritised for collection and how much will its collection cost? When collected, where is the analytic capacity?
Potentially-redundant PCT staff see these GP consortia as their next resting place. Sadly, many of these people are the cause of PCT commissioning failures.
Staffing commissiong correctly
What is urgently needed is a cadre of analytically competent people who know how to access, interrogate and apply the evidence base.
Citizen Lansley is being assailed by clinical advocates of mergers. But the dear man also wants competition - quite rightly. But if you agree to mergers Andrew, there will be fewer providers - i.e. less competition!
Competition and privatisation
Competition thrives where there is excess capacity so it seems to have some effects in London and the North West. If you close hospitals and reduce capacity, you will inhibit competition. Do take care with the medical mafia and their myopic policy advice!
’The Government should urgently require the private sector to submit full HES equivalent data now.‘
What is the role of privatisation? Blair’s expensive investment in ISTCs has had unclear effects. Again this is a priority for Lansley.
Hospital Episode Statistics (HES) covers only the NHS. The Government should urgently require the private sector to submit full HES equivalent data now. This I have pressed fruitlessly for 15 years!
To evaluate the coming privatisation we need databases which provide comprehensive data about NHS and private activity. How else can we audit consultants working across the sectors and see if privatisation “works”? Prayer and good intentions are no substitute for evidence.
If privatisation is to proceed its initial focus should be primary care. There is a need in this sector to move from corner-shop placidity to Tesco-style superstore. The latter could replace GPs with nurses, and use its purchasing power to aggressively commission care from hospitals and other providers.
’If consortia are merged to give purchasing clout, competition will be reduced.‘
Competitive tendering will be needed to drive down or at least stabilise costs. However, there again there are some nice potential problems. If consortia are merged to give purchasing clout, competition will be reduced.
So is the policy to allocate patients not on the basis of geographical residence - i.e. can I living in York become a member of the Exeter GP consortia, which will take my tax funds and use them to buy me health care in York? We will have to read the runes carefully to see how HM Government intends to create and sustain competition.
Until the details of the Tory reforms are clear, we can only muse in the abstract about these issues. However, such musing are essential to draw out the potential conflicts inherent in the reforms outline by the Conservatives whilst they were in opposition.
Onwards to the revolution!?