Monday, March 21, 2011

Reconfiguring Hospital Services - Lessons from South East London

The King's Fund, a UK "watchdog" NGO, specialisng in health service consultancy and often used by the last government to adjudicate in health service "reforms" (i.e. closing hospital services etc), has recently published the above report. The report focuses on the current government's proposals to shake-up (again) the structure of the UK's National Health Service established by the Labour Party's governments of recent years.The main focus of the report is government plans to make economies of scale through the "rationalisation" of District General Hospitals and the restructuring of the entire health service bureaucracy through the Health and Social Services Bill currently before Parliament. However, it makes note of the government's plans for the role of General Practioners (family doctors). I quote ... all square brackets are mine.

"The coalition government’s decision to transfer commissioning responsibility from PCTs [Primary Care Trusts] to smaller GP consortia will further weaken commissioning levers to effect service improvement across trust boundaries in emergency and network services. GP consortia will have even less expertise and commissioning experience than PCTs; information asymmetries will be even more pronounced; and understanding of how to shape the‘quasi-market’ will be even less developed. Since GP consortia will be much smaller than PCT joint commissioning groups, and SHAs [Strategic Health Authorties - an even larger bureaucratic unit within the NHS] are to be scrapped, it is unlikely that GP consortia will be successful in driving major service improvement in emergency and network services."

"Recent successes in stroke and trauma services highlight the potential of strong commissioning to markedly improve patient outcomes in ways that are cost-effective, especially in emergency and network services. This raises the important question of whether strategic planning of non-elective and emergency services to deliver best practice
care for all patients is to take place in future. If so, who will be responsible for making it happen? Since, for the reasons given above, GP consortia are unlikely to be able to fulfil this role, the new NHS Commissioning Board will need to be given the statutory powers and the capability to perform it effectively; and its powers will need to extend to
all hospital providers, not just financially challenged trusts. If the NHS Commissioning Board is not given appropriate powers, then the system will gravitate closer to a pure ‘market forces’ model – with the adverse consequences noted above."

It seems the GPs are not to receive extra compensation for their new responsibilities ... especially given the criticism and "flak" they have received about their salary levels over the last few years. Indeed, the current government is proposing to raise their statutory retirement age from 65 to 68 years!

Three score and ten - now I have two years to live!

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