Monday, 9 May 2011

UK NHS reform GP cynicism

The Royal College of General Practitioners are complaining the proposed government reforms may unravel the National Health Service. The general "idea" is to give control of primary care funding to local consortia of GP's whole then commission services. At the same time the government are proposing to introduce competition for the provision of health services.

We must not lose sight of the fact that most General Practitioners are independent contractors/partners. The GPs do not have a contract of employment with the NHS. The GPs are allowed to keep the profits they make from the fees they charge government for the provision of health services. To allow the GPs to commission their own services represents a gross conflict of interest. Their primary motive is profit. The GPs already receive a massive annual income, as a private contractors, plus many hidden state subsidies. Giving them control of the purse strings is utter lunacy.

The Royal Collage of GPs complain that competition will wipe out the NHS [reduce the GP profit], yet at the same time GP commissioning groups actively campaign to halve the staffing levels of the existing NHS Walk-In Centres. These places are nurse led, using highly skilled medical practitioners, and provide a service 365 days a year from 7am through to 10pm. They handle 90% of the cases GP's handle and in many cases treat the overflow of patients who are unable to get an appointment at their own GP. Most GP practices are open to the public for about 8 hours a day for 250 days a year. The cost per clinical consultation is at the highly available Walk-In Centres is about 75% of an equivalent reduced availability GP consultation. The GPs hate the exposure that properly qualified Nurse Practitioners can provide a good clinical service without the need for expensive GP's.

A telling statistic is the consultation duration in a Walk-In Centre is an average of 12 minutes per person. These Nurse Practitioners are very thorough. Compare that with your own visit to a GP. most of their consultations last 2-3 minutes. The error rates at Walk-In Centres are very low, which is good considering the staff have to deal with unknown patients who walk through the doors.
One of those GPs looking for closure of the WICs is a close advisor of the Health Minister Andrew Lansley. Indeed Mr Lansley has introduced him at public speaking events as a GP expert. That same person is actively involved in the management of a local new GP consortia who will commission health services including the GP practices where the advisor has an ownership/profit interest. Their recommendation is to break up the WIC in his area (about 100,000 consultations a year). The WIC has already had substantial staff cuts imposed.

Not good. These ill consider government proposals have already caused a lot of damage and unnecessary expenditure. Prime Minister Cameron promised to protect the NHS yet he seems to have put it under the control of unreformed self-interest groups.

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