Will patients notice when NHS reforms go live in April 2013?

The biggest reforms in NHS history go live in April 2013, but will patients notice? The strap-line of Andrew Lansley’s baby was ‘no decision about me, without me’ but patients have had little say in the make up or operation of the NHS Commissioning Board, the Health and Social Care Information Centre, Health Education, the NHS Trust Development Authority, Healthwatch England, Local Healthwatch, Health and Wellbeing Boards and Clinical Commissioning Groups. Every year, the Health Service Journal produces a list of the people with ‘ the greatest influence on  health policy and the NHS’, and MD shows it to patients. This year, none could identify any of the top ten (hint: all white men, and four of the top six are called David).

At least Lansley became recognizable, but the current NHS is led by men you’ve never heard of who are miles away. For all the talk of devolving power to GPs, there are none in the top 20 and only one Clinical Commissioning Group chief in the top 100. Anna Bradley, the chair of Healthwatch England, ‘the consumer champion who will make the system listen to the patient voice’ is number 32. Despite fears that the NHS is being carved up for privatisation, the only private sector entries are Ali Parsa (58), who has just resigned as chief executive of Circle, and Richard Branson who has snuck in at 98 by virtue of his 75% stake in Assura and expansion of Virgin health.

A bigger fear for the government is that their hugely disruptive, expensive and widely opposed reforms will make very little positive difference to patients come the election. On top of the ambitious £20 billion savings plan over the next two years, the Nuffield Trust is now predicting a decade of austerity for the NHS, with a ‘funding gap’ of up to £54 billion by 2021/22. If every patient in the UK stopped smoking, ate and drank sensibly, took 30 minutes exercise every day, used condoms, stayed mentally well and only bothered the NHS for vaccinations, it might just survive.

Alas there are lots of chronic diseases without a cure, and these patients take up most of the NHS budget. Lansley’s test of whether the reforms are working is if a patient has a good idea to improve his or her care and takes it to a GP, the GP has the power to make it happen. MD suspects the results will be quite variable, but there are plenty of enthusiastic commissioning GPs across England who are already treating more patients closer to or in their homes, getting quicker access to consultants, getting city centre stores to stop selling cheap alcohol, liaising with charities, social services, pharmacies and opticians and cutting down on unnecessary referrals, A+E visits  and prescriptions.

There are also plenty of GPs in Scotland and Wales collaborating in this way, without the added pressures of a competitive health market, and only time will tell which model works best. And there are demoralised GPs in England who strongly opposed the reforms, think they’ve been stitched up in their new contract and resent the extra work and regulation for less money and pension. They may well have to make redundancies or end up selling out to Virgin.

Even the enthusiasts for clinical commissioning worry that, come April, GPs will be targeted by the press and blamed for hospital mergers and closures, increasing waiting times and lack of access to expensive drugs that are bound to happen in such austere times. Ultimately, the care patients get may depend on whether their GP is ‘energised’ by the reforms, or demoralised. Occasional NHS users will notice little change other than their GP looks even more stressed, but a few will have a personal budget to ‘shop around in the health market’. Those with multiple illnesses and complex needs will find life toughest, unless they’re lucky enough to find a bullet-proof workaholic GP who relishes the extra effort and responsibility of buying them the best care.