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Independents' Day

18 months to save the NHS?

NAPC chair Dr Johnny Marshall on why it’s so important PBC makes its mark over the next 18 months

NAPC chair Dr Johnny Marshall on why it's so important PBC makes its mark over the next 18 months

Following the 2009 budget announcement, it is now clear that the economic tsunami that has been ravaging the world will be felt within the NHS in 2010/11. During that year the NHS will need to contribute an additional £2.3bn towards the required public sector efficiency savings for that year.

Longer-term financial forecasting suggests a real reduction in public spending of around 2.3% per year from 2011 to 2014.

These reductions will be against the familiar context of increasing demands on the NHS as a result of an ageing population and a rise in long-term conditions.

In its 2009 budget analysis, the King's Fund identified that this would be compounded by NHS inputs growing faster than NHS outputs during the 21st century. In other words, the NHS has delivered a lower level of increase in activity than should have resulted from the increased investment. For the NHS to survive the austere times ahead, we are going to need to deliver greater productivity.

This news is likely to be met with a mixed reaction across PCTs. Those that have amassed surplus in seven years of plenty may feel better placed to survive seven lean years and regard a 2.3% recurring annual reduction as no more than trimming the fat. Such complacency would be ill-judged. For others who already operate within tight budgetary constraints, the reduction might feel more like death by a thousand cuts and they should be afraid – very afraid.

In an age of such financial fear there is a danger that PCTs might freeze in the headlights, become even more risk-averse – if such a thing is possible – and ultimately drown in a whirlpool of fear. What we need is for them to jump from the burning platform and entrust clinicians with the future of the NHS.

During the next 18 months we need to move from our current position of varied clinical performance to a position where increases in productivity release resources to support efficiency through improvements in quality.

As clinicians, we will need to play a leading role in this. We will need to catch PCTs when they jump and not simply stand silently saluting their demise. We need to be seeking out transformational changes that will both reduce costs and improve outcomes, and we will need to make it happen. We need to rigorously evaluate what health organisations outside of the NHS have to offer us and, where sufficient value is provided, embed them in our practice.

Clinical leadership will underpin the discovery of solutions and their effective delivery by challenging existing behaviours and demonstrating alternatives. For clinical leaders to be effective they need to be operating in an environment that has a clear sense of direction and is capable and willing to support them.

What we cannot afford to do is delay this clinical engagement any longer. The natural lifecycle of transformational change means we need to start planning now for sufficiently effective delivery to be in place by 2011. This will enable us to deliver both services and a surplus to see us through the challenging years to come without sacrificing the quality of the service we deliver.

Dr Johnny Marshall is chair of the NAPC and a GP in Buckinghamshire

Dr Johnny Marshall, NAPC chair.

For the NHS to survive the austere times ahead we are going to need to deliver greater productivity.

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