Will GP commissioning help patients get better?

I think not. I’ve spent a bit of time reading the new White Paper and associated fluff, I conclude that there are possibly two good things in it. I’ll get to them.

But, oh, the jargon! And the rest of it! What on earth does ‘equity and excellence: liberating the NHS’ actually mean? I’m really tired, bored and frustrated with NHS organisation and reorganisation. I’m also fatigued with the choice agenda, i.e. “choice of any provider, choice of consultant-led team, choice of GP practice and choice of treatment.” Really: do we want this? To organise an entire NHS around a choice which most of us actually don’t want? What about this: “It lacks a genuinely patient-centred approach in which services are designed around individual needs, lifestyles and aspirations.” Okay, I’d like reflexology please, at 6am, on a Sunday, because it’s my lifestyle, and I aspire to have it. That ok? The Paper also seems to think that doctors go off doing all kinds of things without telling patients, and they seem to be crediting themselves with the catchphrase “no decision about me without me.” Dear oh dear – perhaps you’d like to think again about putting everyone’s details onto the NHS spine without asking them first? Then there is this: “We will ensure the right data is collected by the Health and Social Care Information Centre to enable people to exercise choice.” I don’t like the idea of being pushed into making choices – and remember – there is very little evidence that most people want choices about healthcare asides from what is routinely clinically offered. (The White Paper references a survey saying that most people think there should be a choice of medical treatments. Where there is, it already should be offered – that’s a professional clinical matter, not a political one.)

On to GP Commissioning. This is a disaster. The Paper says that because GPs deal with lots of patients, they know what kind of services are needed.To a certain extent that’s true, but it’s not the whole truth. Note carefully:  “It will increase efficiency, by enabling GPs to strip out activities that do not have appreciable benefits for patients’ health or healthcare.” Very good: (that’s one good thing) and  I’d instantly ban any hospital department from accepting referral letters via tickbox form alone – but how on earth can a GP, with perhaps only one person with Parkinson’s disease, and another person with serious burns, know what the best services will be for all patients in the region with these problems?

What is needed is less management, not more: we don’t need a whole other NHS reorganisation to do this, but simply to listen to patients and hospital doctors and GPs on the floor – if NHS management want to keep their jobs, they should simply be implementing the services that people want.

GP Commissioning has the ability to make health inequalities worse. I’m not interested in business models – believe me, some doctors will get powerful and well-off because of it – I am interested in service. The commissioning structure proposed is all about cash, and one could easily see the re-ignition of the old-boy networks as doctors choose other doctors services.

The only other good thing I can find is the White Paper’s intention to make it easier for patients to find out and join in clinical research. But it has to be said that there are many doctors and researchers who have been doing this work for some time already. While the Governments support might help, making it party political may not.

As for the mention in the report about the need for prevention of blood clots via NICE guidance, David and Nick clearly missed my FT column on mortality rates, or lack of them. It’s here.

3 Responses to “Will GP commissioning help patients get better?”

  1. The Jobbing Doctor July 15, 2010 at 5:57 am #

    Thanks, Margaret.

    There has been a distinct lack of comment about this from GPs, but I completely agree with you on this matter.

    Commissioning sucks.


  2. rize haber July 17, 2010 at 4:23 pm #

    In order to meet productivity demands, corporations must rely on a healthful, productive workforce to succeed in the highly competitive global marketplace.

  3. Mr Mature July 19, 2010 at 8:15 pm #

    Good article, well written. I totally agree with you. When will governments learn to stop restructuring the NHS? Cost reduction and efficiency improvements yes, but total restructuring, no. Personally I believe ‘GP Commissioning’ is one of the daftest Government ideas ever put forward. Wouldn’t it be nice to have a wholly independent body advising on the NHS?

    Mr. Mature