by Guest

I am a GP who has been involved in an evolving commissioning consortium (‘pathfinder’ no less), to try to make some sense of the government’s ‘reforms’. Although the Bill has just been released, since the bombshell was dropped with the White Paper in July people have been busy.

Most GPs in our area can be divided into two categories; those who think the plans are bonkers and don’t want to waste any time on it, and then those who think the plans are bonkers but want to limit the damage.

I belong to the second category and I think there is a general view amongst GPs that we are at least a little responsible for the NHS, which most of us are proud of. That, unfortunately, means that when something as massively potentially disruptive to our patients comes along, we cannot ignore it. This shouldn’t be confused with consenting to the changes.

There are a number of changes potentially damaging to the NHS, increased privatisation, destabilising hospitals, price competition, geographic variation in services and quality etc. However, there are more pressing problems that are happening now and are likely to accelerate.

Put bluntly, there is a developing meltdown in the administration of the NHS. As soon as the White Paper came out in July, the whistle was blown to start a period of nearly 3 years of instability and waste in the NHS. This has been made worse by recent policy adjustments. What is happening is that a crucial (and unseen) part of the NHS – the PCT commissioning and administration functions have been well and truly hamstrung.

Where I work, the local Primary Care Trust is generally well respected and does a good job trying to hold down costs at a local large hospital (not an unusual situation). Also, whisper it, but the financial instability had been quiet for a few years now.

Since July, staff have been distracted by the huge elephant in the room – that at least 40% of them will lose their jobs soon, and likely all by 2013. This matters in that if they take their eye off the ball, costs escalate and quality targets deteriorate. Then it is the patient who suffers.

Not only this, once key managers start leaving or being head hunted, key local and institutional knowledge is lost and will take some time to replace. For example, a finance officer who has for years successfully rehearsed arguments with the hospital about how much of a discount the PCT should get, goes, it will take months to pick it up. During this time the budget could be millions over.

It gets worse. Locally, where I work, GPs have sensibly decided to try to preserve the local infrastructure as much as possible and move quickly to set up a consortia to try to keep the managers who know how to do the job. However, PCTs staff are now being centralised in ‘clusters’ of 3 or so PCTs. This robs GP Consortia of local talent. GP consortia also have no way of employing the PCT managers so the uncertainty worsens.

This all leads me to conclude that a large part of the agenda of the government must be to literally destroy the managerial expertise and infrastructure of the NHS. This means that GPs will have no-one else to turn to but the private sector, who will have little local knowledge and an entirely different agenda. The alternative is that the Tories do not understand the importance of NHS managers, which may also be true.

Why does it matter? Well, unleashing chaos within an organisation that can be as fragile as the NHS will without doubt cost lots of money and sadly will lead to, as usual, the most vulnerable and voiceless patients losing out.

The sad thing is that it didn’t have to be like this. Bringing in GP leadership to commissioning and health service planning was perfectly sensible and possible. However, if it had been done within the existing infrastructure the risk lower, the cost less, and the potential damage averted.

So lets nail the lie that ‘there is no alternative’. The NHS was not broken so it didn’t need a radical overhaul, just sensible progression of renewal reflecting its values.