British Conservatives in Paris Blog

Last week Andrew Lansley, the Health Secretary, published his white paper on reform of the National Health Service (NHS).This sets out a policy framework aimed at abolishing Primary Care Trusts (PCTs), giving General Practitioners (GPs) instead the responsibility for commissioning treatment for their patients. Having thus empowered GPs, the Health Secretary then expects them to proactively respond in making informed decisions without seemingly further guidance from the Department of Health. This could lead to the creation of large US-style, privately owned Health Maintenance Organisations (HMOs) which in practice have driven up costs without correspondingly fair and reasonable improvements in US healthcare.
In fact, over the past two years under a practice-based commissioning initiative under the last Labour government, GPs have already been encouraged, should they so choose, to take control of part of the local health budget. For example in Cumbria last year, six teams of GPs each serving a population of around 100,000 have worked with a shadow budget and, as of last April, have been responsible for 60% of the £800 million health budget. A mutual-benefit partnership between the public and voluntary sector is foreseen (evoking the Big Society of David Cameron?) which, e.g. in the case of their more elderly patients would involve Age UK, collocated at favourable rates with the GP team, bringing practical assistance aimed at keeping them in their own homes and out of hospital (a potential saving of £3000-4000 per non-hospitalised patient).
However, the experience gained from the earlier GP fund-holding experiment of the Conservative government in the 1990s, when it was unfortunately decided not to evaluate the actual results from the beginning, also needs to be taken into account. Although the general public received no information on whether clinical outcomes and patient safety or the cost-effectiveness of care were improved, there were suggestions that patients of such fund-holders were often reported as less satisfied with their NHS services, felt knowledge of their medical history worse than before and the willingness of their GPs to refer them to specialist treatment diminished. GPs seemed more concerned with keeping costs down rather than improving care. The complexities of contracting could also lead to any efficiency improvements being offset by high transaction costs between GPs and hospitals, the former often forced to make decisions without accurate information about the quality of the contracting services on offer. Overall, fund-holding was unable to achieve major and sustainable improvements in their hospital experience as far as the public were concerned e.g. in reducing waiting times, something that the NHS reforms of Labour did achieve and that matters to patients.
In summary, therefore, it would appear better to first test these proposed NHS reforms via a limited number of carefully selected pilot schemes, with their clinical outcomes, efficiency gains and cost effectiveness measured against predetermined but realistic targets, to foster the subsequent development and sharing of best practices.

This entry was posted on samedi, juillet 24th, 2010 at 2010-07-24T10:42:58+02:000000005831201007 and is filed under Chairman''s blog, NHS Reforms. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.