The Government are today due to announce what is being dubbed as ‘the biggest planned overhaul of the NHS since its creation’, The Health and Social Care Bill.
The reforms are aiming to pave the way for General Practitioners to gain control of most of the NHS budget and aim to be totally enforced by 2013. The reforms also focus upon the abolition of practice boundaries, where patients will be given the choice of which General Practitioner they register with, regardless of location.
The Conservatives have always been pioneers of this kind of reform, and as part of the Coalition government, they have stated that the changes will bring vast improvements to the care afforded to NHS patients and that accountability will also be improved. They have also stated that there will be more effective and more easily administered safeguards put in place.
Health Secretary, Andrew Lansley, has commented that the Government’s ambition is for the NHS to provide the best care anywhere in the world and that these reforms are the best way of achieving this ambition. He has also commented that the reforms will make the NHS more responsive to patients.
However, not everybody is so positive about this ‘radical overhaul’ of the way the NHS is structured. Shadow Health Secretary, John Healey, has strong concerns about the proposed legislation and believes that much more research is needed before reforms begin. The NHS Confederation has voiced concerns that the reforms could lead to the closure of many hospitals as plans include opening up the NHS to ‘any willing provider’. Other critics have also queried whether General Practitioners have the skills and experience required to handle such huge budgets. General Practitioners are independent and are not employed by the NHS in the same way as other Doctors; I ask whether they can be trusted with such huge budgets?
The current situation
The current situation gives managers of Primary Care Trusts the responsibility for planning and buying local services. Under the proposed reforms this responsibility will transfer to General Practitioners, giving them control of up to 80% of the budget. The Government’s hope is that eventually Primary Care Trusts and regional health authorities will be phased out, with General Practitioners taking over their roles.
At the moment patients are restricted by location as to which General Practitioner they can attend, however the Health and Social Care Bill seeks to change this, allowing patients to register with their General Practitioner of choice, hoping that greater competition will increase the standard of care provided at all practices.
How will the reforms affect patients?
Supporters of the reforms say that the changes will provide patients with a greater involvement in their care and will allow General Practitioners, who have a much better understanding of the needs of each individual patient, to make decisions based on a one to one basis, rather than these decisions being made on a bureaucratic level.
However, there are many critics who believe that the reforms could lead to poorer care for patients.
The changes are being considered in the wrong climate; The NHS has been instructed to cut costs by £20 billion by 2014. This is certainly not a good time for medics to be focusing on both cutting costs and making the changes as it will inevitably lead to less patient focus.
Peter Carter of the Royal College of Nursing agrees with this, stating that NHS medics will be focusing on saving money and making the necessary changes, rather than focusing on delivering quality care to their patients.
As patients, we are all too well aware that General Practitioners are extremely busy people. In a time when many patients already have to wait up to a week, or even longer, for an appointment with their General Practitioner, surely piling more and more work upon them is a step in the wrong direction. In my opinion, patients are going to be left with extremely long waiting lists. Another fear of mine is that whilst General Practitioners are feeling the weight of this increased workload and more than likely, longer working hours, they may be less focused on their patients, leading them to make more mistakes.
The British Medical Association and the Royal College of Nursing have concerns regarding the competition culture that could be created within the NHS by the abolition of practice boundaries, stating that this could remove the focus from providing patients with quality care, with medics too concerned with attracting new patients.
Many of the concerns and criticisms of the reforms revolve around the loss of patient focus and the fear of patient’s being afforded poor quality treatment and care.
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By clinical negligence specialist, Jenny Hornby
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