Saturday, 2 March 2013

What a difference a year makes as NHS Reforms become real.

How interesting… Michael Dixon, Chair of NHS Alliance and Interim President of NHS Commissioners has warned that doctors would "start getting bogged down" in dealing with competition and would end up taking their "eye off the ball". He is concerned that the wording on competition in the Section 75 of the Health and Social Care Act will mean that doctors could get "bogged down" in the process of commissioning and distracted from patient care.

Reality is really beginning to bite for a GP who has been a huge supporter of NHS Reform, which transfers the shift of power to give GPs the majority of the NHS budget to commission care and services. Dr Dixon has been a bullish proponent of GP led commissioning and last year relished the new powers to be endowed on GPs, but his ardour now appears to be waning. What a difference a year makes. Less than a year even. Last May, I attended an NHS Futures Forum and struggled with Dr Dixon’s enthusiasm for this shift in power. An extract of my blog that week follows:

May 18th 2012
‘…..Oh dear oh dear oh dear. I must be very careful how I put this but Dr Dixon’s presentation fuelled my worst fears about the effect of these NHS Reforms. He started his talk with ‘I am an independent contractor, like a plumber’. ….…..Michael is massively in favour of GP Commissioning and leads a pathfinder GP practice. He was in my opinion (I must be careful not to upset my lawyers) positively salivating at the prospect of complete control of a big chunk of the NHS budget. I found his talk of a cafĂ© in his practice, his views on specialist representation and his apparent lack of empathy with secondary care quite worrying……He made no secret of the fact that a desired outcome of the reform and GP led commissioning was to migrate services away from Hospital Trusts. He continued – and I quote, as near as my notes allow, ‘I’ll be moving stuff from hospital to my practice and I’ll get money for it, therefore there needs to be total transparency’.  Baroness Young (the chair of the event) was brilliant as a devil’s advocate with her careful wording. She asked Dr Dixon his view on the fact that many patients, especially those with long term conditions do not wish to be ‘discharged’ from the care of their specialists to be handed over to a general practitioner……I asked Dr Dixon if perhaps that figure [that 30 -40% hospital admissions are avoidable] could be due to the fact that patients couldn’t get in to see their GP and how would GP commissioning improve this state of affairs. For a moment I thought he had morphed into Andrew Lansley as the question was effectively side stepped. When I queried the impression that he didn’t want specialists on ‘his’ commissioning board, he clarified that he doesn’t want hospital specialists on the board who are ‘trying to protect their budget’.  A phrase that springs to mind includes ‘pot and ‘kettle black…….’

Back to the present…
There is some merit in Dr Dixon’s demand that the wording of section 75 of the Health and Social Care Act should be changed as it appears to encourage a scatter gun approach to opening up competition for services which could be unsuitable for private involvement either due to expertise, location or supply issues. Commissioning isn’t easy. If it was, the NHS would be in a better state than it is. I would much prefer seeing GPs looking after patients, directing their care and referring them on to appropriate specialist services. But the nitty gritty of preparing tenders, assessing responses and monitoring contracts is a full time job.

I believe that carefully managed competition in targeted service areas can be a good thing for the NHS. But commissioning is a specialised, time consuming, detailed and burdensome job. Being a GP is a specialised, time consuming, detailed and burdensome job. How can GPs realistically be good at both? Dr Dixon continued in his interview with Pulse magazine that offering the tendering process for most NHS services to private firms could mean that the reforms are ‘a complete waste of time’ and that ‘GPs will walk’.

Last year, referring to his desire for autonomy and lack of interference, Dr Dixon famously said ‘GP’s don’t want to be managed – we want to be seduced’

Fun as seduction may be, it often results in consequences that aren’t always positive. I am tempted to say ‘I told you so’.

Instead I shall settle for ‘Be careful what you wish for….’


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