The current UK Government is proposing a radical approach to commissioning care by giving GPs control over budgets totalling £80bn. Currently, health service managers in strategic health authorities and primary care trusts manage these funds. Westminster argues that this will save large amounts of money by removing the need for managerial staff while giving doctors greater control of the NHS purse strings. This is the latest in a string of gradual privatisation of the health service, first started in the early 1990s by the then Conservative Government, who introduced GP fundholders in charge of commissioning budgets. Labour then launched its own policy of a practice-based one.
Various medical practitioners have said that while the proposed changes do give GPs the chance to exert more influence on the commissioning of health services for patients, they also highlight several difficulties that are likely to occur. Firstly, the change will mean GPs must make informed decisions about the treatment they are proposing for their patient. That means knowing all the services on offer, their merits and who is practising. Given how little time most GPs have to spend with each patient, I’m not sure when they would do this. The administrative burden of a new untested commissioning system would not really help face-to-face patient contact either, regardless of an individual’s computer skills.
Also, how would an individual GP or a practice take on the role of reshaping local health services to meet future needs? Is this something we want already over-stretched doctors take on? That’s without even thinking about how the NHS or Ministers would keep control of health-spending under such a system. Another issue is whether all surgeries would have comparable budgets, say an average budget per patient. Would this lead to surgeries in more deprived areas having to limit the care they offer to patients as they are more likely to have chronic health problems? Would patients in affluent areas have a greater level and access of care since in total they had less ailments? Would we see surgeries rejecting a new patient based on their socio-economic background, their occupation or even which countries they had visited in case it led to a drain on the budget? Perhaps that is a horror story but you just have to look at how the partial privatisation of dentistry has led to people not seeking treatment for fear of the price they will have to pay.
You have to wonder if medical school takes so long because the human body is so complex or to teach trainee doctors how to administer and commission services. You know, handle population level data, negotiate contracts and then monitor their performance, determine health policy and suitability for their patients, that sort of stuff. I really do hope it is the latter.
Anyway, as I said at the start, this privatisation by a thousand initiatives is happening south of the border, not in Scotland. We would never let it happen here. Would we? Would a Scottish Government facing a smaller budget want to introduce something they think will make the money go further? No, I can’t believe that would happen.
Instead of dwelling on a potential horror story re-make, let’s instead look at things that could improve the Scottish NHS. Obviously, the first thing the incoming Parliament and Government should do is agree that health is not a privilege but a basic human right. This is one issue that is too precious to put in the hands of commercial conglomerates. The new and returned MSPs should make it plain, to the country and others, that in Scotland the NHS will continue to provide free healthcare at the point of use, with no privatisation. This includes free prescriptions for all. Our National Insurance contributions are meant to fund that care so we shouldn’t have to pay twice. If you feel you can afford to pay, then ask your GP or pharmacist if there is an over-the-counter alternative. That should assure any guilt you might feel. If that is not possible, then donate to a heath-related charity. While we’re on the subject of prescribing drugs, are there not generic drugs that NHS Scotland could use rather than brand names? To really push the thinking, could the Government not set up a lab to produce the drugs themselves, creating jobs for a skilled work-force and saving money at the same time? We should also support initiatives that allow the NHS to manage and improve itself. This is achieved more easily from within than by imposing targets from above.
Lastly, how about improving health education, for children and adults alike, as well as instilling a greater sense of responsibility for our own ‘healthstyle’? The Government, our GPs, schools and politicians should all encourage a healthier, more active lifestyle. This should also include better access to information on how to improve the way we feel and live. Several friends of mine suggest that patients should have the option to refer themselves to a specialist. That reduces the administrative pressure on GPs and helps the patient to take responsibility for their care. If each surgery had templates it would be a simple task for a doctor to electronically link the patient’s name to the type of referral they need. If the system was robust enough, they would collect the letter by the time they reach reception. That would give the patient more responsibility for their care, cut out the delay while the surgery deals with the referral and possibly money as well. The GP would not have to choose this option but could use judgement to decide whether it was suitable for the patient. They could also then check up if they were concerned over whether the patient had seen the process through.
Of course, this would take a re-organisation of the central admin but, if it was done right, there are benefits to that. From my experience that wouldn’t be a bad thing. My last appointment with a consultant was on the same day as a CAT scan. I had ‘phoned the hospital office to check having the scan in the morning wouldn’t mean the results weren’t ready for the meeting. I was assured that was not a problem. Of course, when I did see the consultant, I was told I would have to wait another ten days for the results. While I was confident that the scan would not show any problems, not everybody will have that luxury. The fact that I had to chase the office for the results shows that the current system needs improving.
Simplified access to health care might even give GPs a chance to talk and listen to their patient more rather than watching the clock. Any time I’ve had a doctor who does spend time with me, they are inevitably running late throughout the day. Why do we think that a ten minute, one-size-fits-all appointment is going to suit every case presented? Why not introduce some flexibility to the initial point of contact?
In the new parliamentary session, whoever is elected, lets demand that our politicians work together to improve both the nation’s health and the NHS in Scotland. An old Arab proverb says “He who has health has hope; and he who has hope has everything.” Let’s build a better Scotland by making sure we are all hale and hearty, leaving behind the unwanted image that we’re the sick man of Europe.