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Pandora's box

Ever wondered what was in the box? More patient activity than ever, that's what

In terms of creating demand for GP services, the Government's most recent wave of reforms has opened Pandora's box. And that may explain the otherwise inexplicable return of fundholding ­ sorry, commissioning ­ spectacularly abolished in 1997. It worked well for some patients, but not for those excluded under the two-tier system. And the maths must have been pretty bad as PCTs ended up having to cap fundholders' savings to avoid huge payouts from NHS coffers. But now commissioning's back, simply because there is no other way to replace the lid or stuff the genie back in the bottle.

Reform in the NHS has continued at an unprecedented rate. We now have targets for pretty much everything you can think of. GPs and consultants have new contracts, A&E waiting times and waiting list targets have been thoroughly massaged and overhauled. Advanced access is here to stay and a fantastic new computer system that will work seamlessly and never break down is currently being built in cyberspace.

Supply and demand

But hang on a second. There have been murmurings for some time as to why the vast sums of money that have been deployed have taken so long to deliver any meaningful change. Even now, some would argue working at the coalface is little different.

How many more GPs are there in your town now compared with 1997? The answer is much the same on a whole-time equivalent basis. But the fact is, demand has gone through the roof. Patients can phone to be assessed the same day. They now pitch up with a whole list of problems to fix in 10 minutes.

They come to reception on the off-chance of being seen straightaway. I've even heard of some punters dropping in at hospital clinics with their referral letters.

Patients even get cross when private correspondence and holiday forms take 24 hours to turn around.

The public perception is that the NHS has been paid for with taxes and an expectation to meet the hype has been created. We are the frontline in all of this and the sharp end of the pointy stick is aimed squarely at us.

Putting a lid on it

Fundholding ­ sorry commissioning ­ has been rebranded first and foremost to ration demand. Forget the nonsense about devolving local health care. Fundholding was the single most successful policy in the history of the NHS for controlling referral patterns.

The only realistic way to improve current services is to cap the unprecedented levels of patient activity swamping the NHS on a daily basis.

A leading health article about the NHS reforms recently said: 'This may hurt a bit.' No kidding, this is smarting already. Are we are going to try to put a lid on the NHS box? If so, we are going to need hope in good measure if commissioning is going to work.

Dr Andy Jones is a GP in Stamford, Lincolnshire

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