Wednesday, July 14, 2010

Another Mickey Mouse makeover for the NHS

Based on the information relayed by the Independent this new makeover for the NHS, the "sixth major reform of the service in 20 years", looks as likely to succeed as all the others. Essentially it is about shifting the management of the budget from 302 Primary Care Trusts (conceptually similar to NZ's PHOs) to groups of GPs, and allowing patients to register with any practice they like.

Why does it look unpromising?

Groups of GPs organised into consortia are to be given freedom and responsibility for buying care from local hospitals and other providers, including private organisations, in a major switch of purchasing power from central management to the surgery.

There's that freedom word again. Getting a lot of that out of the UK at the moment.

But read on;

"GPs can't generate a surplus and pocket it, nor if they fail will they become personally liable."

If the GP does not have the freedom to make a profit if he runs an efficient service and he does not have any responsibility for losing money if he runs an inefficient service he doesn't have freedom and he doesn't have responsibility. He's still a semi-public servant on the tax-funded payroll, albeit highly trained.

But what is the problem they are trying to fix? Rationing, waiting-lists, lack of patient choice.

Say you had a car, most of us do. It periodically needs a check up and sometimes gets sick. Imagine the government holds the funds for the provision of these services. The funds are distributed via Primary Car Care Trusts. My local mechanic must apply for the funding to fix my car or arrange for it to go where it can get fixed. I don't have to pay him directly because I already paid him through my taxes. Great. Except there is a really long queue to get my car in because servicing and repairs are 'free'. And then when I do eventually get a slot it needs electronic work that he can't do and there's a new queue to join for that 'free' service. I am going to be walking or bussing it (although the buses are subject to the same shortages) for some time.

Based on this latest brilliant idea, giving the mechanic the 'freedom and responsibility' to deal direct with the ancillary suppliers, still publicly funded so 'free', will make the queues go away. And the government says I can now start going to other mechanics if I want to, which will also make the queues go away. But why would I want to? The next mechanic has no incentive to be better than the first. He's just working for the government (notwithstanding he has to fund his own premises and overheads either from what they pay him or what they allow him to charge me) with no prospects of becoming more profitable or going out of business. What's changed?

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