NHS reform – is it really that radical?

A great deal of heat and very little light is being generated about the NHS reforms with the debate largely focussed on the issues of increased competition and privatisation of the NHS. On the ground the reality is somewhat different. Which is the best part of the NHS: the part that regularly scores highest in patient surveys? The answer is almost always, the GP Surgery. It’s the part we love the best and feel most connection with; statistically is the most effective and cost-efficient. There is a real irony here which seems to have been missed by the media and even coalition Ministers – almost all GP Surgeries are private businesses and have been from the day the NHS was founded.
When we enter our local GP Surgery and see the NHS logo we can be forgiven for thinking we’re in the Public Sector. But the free service we receive at the point of delivery in GP Surgeries – the promise made post-war by the NHS – is largely achieved by contracting with private businesses and social enterprises. No-one, it would appear, is taking the longer or considered view of the proposed changes.
The principle of the Health & Social Care Bill is to put clinicians back at the forefront of leading and providing services for their patients – as it used to be in the NHS before layers of managers and commissioners were added in successive reforms starting over 35 years ago. This has to be right – it’s GPs who hear the demands and the complaints of patients across their desks every day.
The new Bill sets out to ensure that providers can deliver services in the same way as GP Surgeries do today. As long as the new system is simple and not weighed down with red tape, the best services will attract the most patients – judged purely on quality and performance, not price. This can only increase quality and performance everywhere as the best services are replicated and contracted to replace those that are poor or failing. Even these elements are not new, the policies and processes of Any Qualified Provider or Any Willing Provider has been around for many years; as has the Choose and Book system in the GP Surgery. But few patients either know about the options or have the confidence to insist upon their choice.
I am not suggesting that every clinician is excited by the prospect or that there are not misgivings about the burden of yet more changes, but if my own contacts in the fast-track commissioning groups are anything to go by, there are more than enough enthusiasts to make it work. It only takes a few professionals in each locality; GPs, GP Specialists, Nurses and Consultants, to serve on the committee to ensure success. Even this is nothing new, most localities have had Primary Care Groups for years – but PCGs didn’t have control of the budget or the authority that the new groups will have. The accusation of lack of management experience is a red herring; groups will have the same support as commissioners do now – and don’t forget GPs have been successfully running their private GP Surgery businesses for their entire careers.
As a social entrepreneur and strategist, I have worked as a specialist in this field for most of my life. Some of the most valued social care and community health initiatives are already run by the voluntary sector or social enterprises; the Healthy Living Centre movement has been largely credited to Blackthorn Trust, a GP Surgery in Maidstone, Kent. I have no doubt whatever, if social enterprise is given the chance it can delivery very high quality local health services to meet patients demands. To judge by the amount of support being requested across the UK, social enterprise just can’t wait for the Bill to be enacted; we can only hope that it survives without being mangled to the point of castration.

Posted on February 8, 2012

Posted by charles