01 April 2010


The Conservative Party promises change but as far as the NHS is concerned their policy seems much the same as that of the present incumbents. This is despite an all party committee of MPs drawing attention to the unknown costs of a failed NHS internal market and suggesting that the the purchaser/provider spilt "may need to be abolished". You might think that the Select Committee's tentative conclusions about the costs and waste of the internal market would be worthy of banner headlines. Even more worthy of a headline is that the Department of Health actually has no reliable measure of how much the commissioning process costs. But you won't find many headlines. The reality is that there seems to be no public discussion on the way forward and both Conservatives and New Labour seem intent on blundering on.

Are there any new ideas out there? There are rumours of one. Many years ago when fundholding was in vogue an effort was made to give GPs some control over hospitals. The idea essentially was for GPs to purchase care on behalf of their patients. It looked as if it might be working but New Labour then decided to do in another direction. The two tier approach was unacceptable to Labour and their replacement system never worked.

So what is the new idea? Rumours are that the next big plan is to put hospitals in charge of GPs. It is not as daft as it may sound. What you do is give the money to a large Foundation Trust and tell that Trust to run all healthcare in their area. A Foundation Trust is able to make a profit and there will be various incentives for the organisation to run healthcare as cheaply as possible. Doctors will be in charge.

The advantage to such a system is that primary and secondary care will become closely integrated and that care will be provided either in hospital or in the community according to where that care can be provided most cheaply and effectively. There will be no purchaser/provider split but private organisations may be hired by the Foundation Trust as necessary to deliver care.

Now what do you think of that?


Dr Russell Brown said...

I think it would be a disaster, sounding the death of General Practice in this country. A quick route to a salaried service which patients will almost inevitably find less satisfactory than the current system. Thre will be little continuity of care (which is not the same as continuiuty of record as some would tell us).

It would not be doctors running the show, but management, with their own or the DH agenda firmly in prime position.

Financial balance would remain the name-of-the-game.

It is dangerous as a concept.

Anonymous said...

I've put up with a lot of crap in the past 5 years as a GP, but if this comes in, it's bye bye to the UK from me!

Foundation trusts are a seriously bad idea and a big step into wholesale privatisation of healthcare.

Anonymous said...

I hope this is an April Fool's Joke!

Dr Aust said...

I can't tell whether you're joking or not, Dr G. Of course, this sounds in some ways not dissimilar to the Kaiser Permanente system that they have in California, which we know both NuLab and the Tories have been interested in.

[I hear California is now bankrupt. Hmmm...]

On balance I think this is both your 1st April wind-up and a prescient warning about how we might get "sold" HMO type insurance-based care by the back door. If we hear that something like this is really happening post-election then we will know the NHS is as dead as Monty Python's parrot

Old Codger said...

"Doctors will be in charge."

I doubt that very much. Managers, with little or no clinical knowledge, will be in charge. It will be a disaster.

Dr No said...

I agree with Dr Aust - this has more than a whiff of American managed care organisations about it - but my money is on the date. If this isn't an April Fool, then Dr No will eat his left hand. Control wires and all.

Cockroach Catcher said...

I was there at the start of the Fund Holding New Age wonder time and one of our local FH GP group referred so many that they were getting all their varicose veins done before any of the non-FH GPs can get serious surgical or whatever conditions dealt with.

Guess what: they could not pay and owed our Trust nearly 2 million. They sent in the bailiffs.

It was just so unfair to the others.

The problem is that many in the current set-up know that their days are numbered and their contracts have great lawyers writing them that the severance packages will cost a lot.

Imagine doing an internal market thing in a family and Darren and Sharon decided to buy their meals at the neighbours and the mother charges father for services.


The Cockroach Catcher