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GPs buried under trusts' workload dump

Red tape won’t be all that’s cut

NHS savings are not just set to come from waste management and process streamlining – NHS effiency guru Dr Lynne Maher is planning more radical action. Brace yourselves...

NHS savings are not just set to come from waste management and process streamlining – NHS effiency guru Dr Lynne Maher is planning more radical action. Brace yourselves...

Efficiencies, it seems, are the new cuts. Politicians may be squeamish about proposing full-blown hacks to the NHS budget, but they are positively evangelical about the need for trusts to drive down costs by eradicating waste. Shadow health secretary Andrew Lansley has pledged to take £1.5bn of bureaucracy out of the NHS. Trusts themselves are competing for who can be toughest on inefficiency, with one saying it planned to reduce the cost of primary care contracts by as much as 30%. And at the NHS Alliance conference, health minister Mike O'Brien's insistence there should be no ‘slash and burn hacks at budgets' sounded hollow when set against NHS chief executive David Nicholson's desperate portrayal of NHS finances. He told delegates the financial challenges would be ‘massively greater than anything any of us have faced'.

But although there seems a consensus that the NHS must safeguard its future by transforming itself into a sleek and efficient machine, there has been remarkably little by way of detail. ‘Red tape', ‘management costs' and ‘bureaucracy' have all been earmarked for the chop, but doctors, nurses, hospital beds – all those things the public tends to like – have remained off limits. That's why Pulse's interview this week with Dr Lynne Maher, the cryptically named head of innovation practice at the NHS Institute, is so illuminating.

Dr Maher, the health service's cutter in chief, has none of the reservations of her political masters, and her concrete suggestions for NHS savings are bound to raise eyebrows. She insists hospitals must cut bed-days to such an extent that they are able to close down whole wards. And, to free up GP time for all the patients fresh out of hospital they will need to see, she proposes limiting how often the chronically ill can visit a practice. GPs, she insists, should no longer agree to see patients every three months. These are real cuts, with the potential to bring real savings. Unfortunately, they could also cause real pain.

The NHS Institute for Innovation and Improvement, to give it its full name, is far more influential than its public profile would suggest. It sets benchmarks across the NHS for use of generic drugs, length of hospital stay and rates of GP referrals. It is never going to be popular, as Dr Maher openly admits, but it does have an important role to play. That role is much more difficult and sophisticated than simply scanning the NHS budget for bits it can snip off. It must provide robust evidence that the savings it proposes will not damage patient care and carry out thorough assessments of those it has implemented, to make certain patients are not suffering.

The institute has not yet won the argument that cuts in bed-days can be introduced safely, mainly because in many areas they have not been accompanied by effective discharge services or the transfer of resources to primary care. Until that happens, GPs will continue to regard the proposals with suspicion.

Some may even take the NHS Alliance's lead and look for an alternative source of savings – a cull of the NHS's large number of advisory quangos, perhaps?

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