All entries for Thursday 17 November 2011

November 17, 2011

The health bill and what it means for GPs and patients

Veronica Wilkie

GPs have been in the news since last summer because of what has been seen as a controversial health bill. Here, Dr Veronica Wilkie, Senior Clinical Teaching Fellow at Warwick Medical School, gives a beginner's guide to proposed changes.

'Liberating the NHS' was published as a white paper shortly after the Coalition Government came to power. At its core was a drive to increase the input of 'coal face' GPs, and reducing what was trumpeted by the newspapers as unnecessary middle management and bureaucracy. You will all be aware of the incredible amount of news that this generated and GPs and myths and legends that were reported by the media. As a result there was a 'pause' in the Bill and The Future Forum, lead by Professor Steve Field, undertook a listening exercise. There were 4 core themes:

  • Choice and Competition
  • Public Accountability and Patient Involvement
  • Clinical Advice and Leadership
  • Education and Training

The report (and it’s a very readable report) came up with a number of key suggestions for change: competition must be used to improve services and regulators should not encourage competition for its own sake; increase integration rather than competition; be careful about fracturing systems of workforce training. It also recommended that the commissioning groups should be clinically lead, not GP lead.

As a result things have moved on in the NHS, although the bill hasn’t yet finished its passage through the eagle-eyed House of Lords. There has been a significant amount of structural change within the NHS, and a change in how many managers there are, with many excellent managers being lost to private sector employment due to the uncertainty over their future careers. It’s worth noting that delivering healthcare is complex and requires good managers as well as good clinicians. GPs now work with 'Cluster PCTs' often covering a quarter or a fifth of a whole region, and the strategic health authorities (SHAs) that used to lead the NHS direction are now no longer regionally based but work as cluster SHAs covering several regions.

Every GP and GP practice is now interacting with Clinical Commissioning Groups (CCG) that are starting to commission in shadow form. These often have very few people working with them and are still under the direction of PCTs whilst they go through a series of accreditation steps, ensuring that by the time April 2013 comes commissioning is handed over safely and with continuity.

These changes have also come in a time of huge economic uncertainty and although money in real terms increases in the NHS, it in no way keeps pace with healthcare inflation. There are huge challenges and the NHS has never needed clinical leadership more. A paper in the BMJ last week showed that General Practice and Pharmacy (largely in primary care) were the only sectors of the NHS that had managed to reduce their costs, with all other aspects of the NHS actually increasing their spend year on year. Primary care costs less than 20% of the NHS budget but carries out more than 80% of the activity.

Many CCGs are interacting more with local practices and all clinical professions than the PCTs had done so before the Coalition Government came to power, and experience within the Institute of Clinical Leadership at Warwick Medical School which runs action learning sets with CCG Boards, clinical leads in primary care and with clinicians in secondary care, shows that there is some excellent work occurring to integrate patient care.

Clinicians are working across the primary and secondary care sectors to integrate care according to the needs of patients rather than the needs of the institutions and financial contracts, working in creative ways to keep patients cared for safely in their own homes rather than being admitted to hospital. However much more needs to be done, and there needs to be more openness and dialogue with patients, their carers, and those who commission and provide healthcare before the NHS can really say it follows the central tenet of Liberating the NHS “No decision about me without me”.

Patients need good quality healthcare; it’s a brave government who interferes with what the public perceives as their NHS and every one who works for the NHS needs to look within themselves to provide the shared leadership skills to make this change and any future changes in policy work.

Find out more about the Clinical Leadership courses at Warwick Medical School.


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