Saturday, 16 March 2013

As predicted – NHS reform is proving to be divisive.

 Perhaps it’s because I was brought up as the difficult middle child, but I love a good spat – it gets issues out in the open and can often clear the air. If only it were that simple with all the siblings of the complex NHS family, a family that appears to be more dysfunctional by the day as the Health and Social Care Act is implemented.

No-one could doubt  the good motives of the former Health Secretary Andrew Lansley as he formulated the transfer of power to give General Practitioners not only the lead when it comes to commissioning of services, but the key to around £60 billion. But as many of us are already aware, the consequences of these changes are not all beneficial.

As predicted, GPs appear to fall into three camps. Those who don’t want all the hassle, paperwork, responsibility of balancing commissioning with face to face patient time and therefore vote with their feet through early retirement. The second group are probably the silent majority who either take an active role in a commissioning group because ‘if you can’t beat ‘em join ‘em’ or maybe take a lesser commissioning role while trying to spend as much time with their patients as possible. And the third, possibly more vocal and active group are those who favour the changes, relish their new found spending power and appear to be planning world (or at least UK) domination.

Those GPs who embrace the additional responsibilities placed on their shoulders by NHS reform are to be congratulated and supported and I have no doubt that many of the clinical commissioning groups will do an excellent job in difficult circumstances, especially when they have the good sense to bring in the appropriate commissioning and clinical pathway mapping experts. But I fear that the side effect of the bullish comments by, for example, the NHS Alliance could do much to damage interdisciplinary relationships and ultimately the patient experience and clinical outcomes.

Without doubt, the priority for any health professional must be joined up care for patients – literally from cradle to grave. Forgetting this awesome timespan, let’s just focus on a patient needing some non-urgent care that may involve some sort of surgical or specialist led intervention. In an ideal world, the clinical pathway for the patient’s condition has already been agreed within the local CCG and this pathway entails full cooperation between primary and secondary care. But according to a letter to The Times newspaper by Drs Michael Dixon and Chris Drinkwater and some of their colleagues ‘hospitals are dangerous places’ and they must ‘as an immediate imperative, shift all non-urgent care into the community’ One could argue that this makes sense but it must be viewed in context. Services can only be shifted into the community if the infrastructure creating the desired capacity is there.
It isn’t.

The letter goes on to mention the NHS Alliance Manifesto which is ‘formulated by frontline doctors, nurses and professionals in primary care’ Manifesto? A manifesto can be defined as ‘a published verbal declaration of the intentions, motives, or views of the issuer, be it an individual, group, political party or government’. This very much suggests a group in isolation of the whole NHS family. The NHS Alliance manifesto spells out some worthy aims but is positioned in a political, territorial way. There is more than enough bad press about hospitals without such powerful GPs proclaiming what dangerous places they are – just imagine how a Times reader with a visit planned to hospital this week must feel?

Needless to say, two days later, a response from a surgeon was printed in the newspaper and he politely points out that one of the issues with non urgent care is that over the years he ‘has witnessed a derogation of out of hours care, exacerbated by the GPs contract in 2004’ and doctors deputising services are often ‘staffed by doctors who do not have requisite skills’.

Fair point well made.

So there we have it – just one small, but potentially significant spat between primary care and secondary care siblings generated by the parent who didn’t think things through when dividing the spoils of his inheritance.

What a sad reflection of a familial relationship that should engender the very best for the patients in our care. It has  generated some unwanted side effects for professionals, trying to do their best for their patients but having to win ground and hold position all at the same time.


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