Tuesday, 27 December 2011

The best laid plans....

As Robbie Burns said over a century ago, ‘the best laid schemes o’ mice and men gang aft agley’. For the non-Celtic among my readers – the best paid plans often go awry. And so it is with the Health and Social Care Bill.

Andrew Lansley, UK Secretary of State for Health has created his NHS reform plans on the basis that the lion share of the annual state funded health budget should be handed to GPs. They would create Commissioning consortia, responsible for treatment pathways, resource allocation and direction of care. I won’t bore you all again with the extensive list of organisations, professional bodies and medical commentators who warned that this was an untenable and badly thought out premise. Despite the NHS Future Forum exercise and some re-working of the Bill, anxieties are still manifold and practical difficulties continue to emerge.

An article in today’s UK Daily Telegraph regarding GP numbers provides a stark reminder that plans for change, any change, should be formulated with reference to their specific context. It is generally accepted that the ideal size of patient list per GP is between 2000 and 3000, but the article estimates that over 1 million patients are registered with a GP who is responsible for over 3000 patients. And this burden is before additional commissioning duties are accepted.

The article goes on to report that GP numbers are falling, with 7% less trainees this year and quotes the British Medical Journal survey which estimates that 1 in 8 GPs are expected to retire within the next 2 years. There are various reasons given for this loss of resource, including the influx of Asian doctors in the 1960’s and 70’s now due for retirement and the growing number of female GPs working part time due to family commitments. But I suspect there is also a significant number of doctors taking early retirement because they ‘simply can’t be doing with’  the reforms and the additional burden the Bill places on them. I personally know three such GPs, all excellent practitioners who will be hanging up their stethoscopes at least five years early for this very reason.

Lansley should have taken all the above factors into consideration before trying to reshape the NHS. However good his plans are in theory – if there aren’t enough GPs then we will face extreme difficulties with access to care in the not too distant future. Lansley is right that primary care is a crucial starting point (after public health of course) in the health and wellbeing of the nation. Many of you who were unfortunate enough to be unwell over the Christmas period will have experienced the delight of trying to access primary care out of hours. It is the basics, the resources available, the quality of personal and clinical care provided, and most of all access to care which should be addressed.

In the meantime anxieties about reform and the much beloved NHS continue to build – again beautifully summarised by the Scottish bard…

‘Our sulky, sullen dame, gathering her brows like gathering storm, nursing her wrath to keep it warm’


Rob Halkes said...

Having read and reread it, it seems wrong to me, to state that plans go awry because of shortage of GP's. As we see this in the Netherlands with the primary (family) health care groups, there is more to the expected changes, specifically related to chronic care pathways, than just availability of GPs.
Evaluating plans for change of care with just a mono perspective, is more a sign of unwillingness to change/innovate, than a evaluation of a multifaceted problem..imho...
Thx for taking my comment

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