What a difference a week makes. Or does it?
Just back from a week-n-a-bit’s holiday to see copious smoke arising from the media & Westminster about the health bill. It will be interesting to see how much this changes what we are already doing.
Several issues appear to be conflated in the general discussion:
- GP commissioning. There seems to be general agreement that more involvement of GPs in the commissioning process is important. I think that the getting ordinary GPs to think about the resource utilisation of the whole population is the “golden nugget” in the reforms. The question for me is how to get this? Just pushing the reset button on PCTs seems doomed to repeat history. The challenge should not be to get managers to involve GPs more in commissioning (which has failed in many PCTs) but to make GPs, as accountable commissioners, see the value of excellent managers.
- Specialists in Commissioning: This is clearly hugely important and it would be wholly unacceptable for GPs to redesign pathways about specific diseases without the inclusion of their specialist colleagues. I know that most consortia are already doing this as well as engaging a range of other clinical colleagues.
- Competition. This is a touchstone for much of the dissent. Some potential softening has already been indicated in the hard line market-driven approach initially proposed. I wonder how necessary further pressure is, given that NHS expenditure through independent sector providers is rising exponentially already. According to Ernst & Young analysis of DH figures, it has risen from £50m in 2006 to over £400m in 2009-10.
- Integration of services. With even Mark Britnell, KMPG champion of the market, agreeing with NHS Confed’s Nigel Edwards on Newsnight that there is strong evidence in favour of integration of health services, perhaps the time is now right to discuss how integration of service provision could be allowed in the new NHS? I know many GP consortia leads who would be keen explore this option.
Whatever the outcome of this period of reflection, we must not let go of the golden opportunity to get GPs properly engaged in population health. And we need to keep the momentum going. Delay equates to doubt in the minds of those who have to make the change work, both clinical and managerial; lack of strong, shared purpose is surely our deadliest enemy in these challenging times.