Christmas Massage

We all know what’s wrong with the NHS. There are too many hospitals swallowing too much money, and too many patients swallowing too many calories. Labour got NHS funding above £100 billion a year, cut waiting times and improved patient care and satisfaction overall. But they failed to get healthcare closer to home, failed to get people to take more responsibility for their health, failed to spot and stop appalling health scandals and failed to narrow the gap between rich and poor. So now it’s the Coalition’s turn to fail.

There are some good ideas in the White Paper, most notably that clinical staff should have more responsibility for planning services and rationing healthcare, but it’s being done at ridiculous speed. The perceived wisdom of NHS reform is that you spend the first year blowing everything out of the water and then next four picking up the pieces. Abolishing strategic health authorities and primary care trusts may be the right thing to do, but doing it all at once sends NHS management into free-fall just at a time that it’s supposed to be making huge savings.

The NHS budget has increased year on year for decades, allowing it pay off its debts with next year’s increase. Now the budget is flat-lining, debt will rise sharply unless unprecedented £20 billion ‘efficiency savings’ can be made, something the Coalition has cleverly branded ‘the Nicholson challenge’ to ensure the NHS chief executive takes the blame when it all goes tits up. PCTs are already feverishly rationing care to balance the books this year, and patients are either being denied treatment or having to wait more than the NHS constitution’s meaningless pledge of 18 weeks. The financial squeeze will kick in over the Autumn, and the cuts in social care will inevitably hit the NHS as the desperate pitch up to GPs and casualty. Next winter could be a bad time to get sick.

Whether GP consortia will have made an impact by then is anybody’s guess, and an anxious Treasury has stopped the Health Bill appearing before Christmas. GP commissioning can only work if the consortia have the money to develop community services, the balls to stand up to hospitals and the openness to involve the public in any changes. The premise is that it takes a thief to catch a thief. Doctors are the best people to find other doctors who’ll do it better for less.

Dr Kosta Manis, a South London GP, has designed a rapid access chest pain clinic in the community at a cost of £800 a patient compared to £1,500 charged by local hospitals. In the first seven months of the year he saved £300,000 by forming partnerships between GPs and specialist centres. Consultants from Guys and St Thomas’ run clinics in four local surgeries and, if needed, the patients get door to door transport to the European Scanning Centre on Harley Street for a state of the art scan that uses only a fifth of the radiation of conventional scanners. It’s faster, safer, cheaper and more convenient than going to the local DGH, and all on the NHS.

Bexley Clinical Cabinet (sic) is one of 54 ‘pathfinder’ consortia that health secretary Andrew Lansley has given the go ahead to prove his point that GPs can be trusted to manage £80 billion of the NHS budget. But who will be holding them to account? A colleague who asked to read the board minutes of Stockport Managed Care was told they were ‘for board members only’. Secrecy in the NHS is strangling trust. All GP consortia need to publish the minutes of their meetings in full, without patients and the press having to issue tedious FOI requests. Accounts of how every penny is spent need to be published. First class rail trips to London and fact finder missions to America must feel the force of public scrutiny. NHS Hospitals still buy the silence of whistleblowers to bury bad news. If GP consortia continue this secrecy, they are doomed to fail. When you wish your GP Merry Christmas, ask him how much he or she earns. It’s your money, after all. (MD is on £50 an hour, no holiday pay or sick leave.)

Quote of the Year
‘This Inquiry was only established because of the articles in Private Eye and, had it not been for them, the issues would have continued to be ineffectively addressed.’

Bristol Pathology Inquiry Report (The full report, comments and a list of GP Pathfinder Consortia are at www.drphilhammond.com