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At the heart of general practice since 1960

Tests that push up GP workload

andy jones

The summer of our discontent?

Who said it's the quiet season? Andy Jones hears the distant sound of autumn's war drums

In the summer it can often be a struggle for columnists to find something to write about. Not this year. The NHS finances seem to be in a right old state.

First, NHS chief executive Sir Nigel Crisp asked all PCTs to make management savings of 15 per cent. (In the space of two weeks they had managed to fit together plans to reduce their number and reconfigure boundaries.)

Second, the Healthcare Commission (the performance regulator) and Monitor (the foundation hospital watchdog) told finance directors in no uncertain terms to put their house in order. The summer started with the National Audit Office citing an NHS deficit of £90 million. The real figure is closer to half a billion, but the Exchequer has issued a few helping handouts.

Twitchy executives...

During the summer I have seen twitchy senior executives reorganising and shrinking the number of PCTs, while ward closures have been enforced all over the place by finance directors. Westminster closes down for the summer but I didn't realise a host of NHS services had to do so too.

Patients are beginning to feel the effects of new accounting practices in the NHS.

The King's Fund is predicting that payment by results may cause some hospital trusts to go bust. We could see the start of pitched battles between primary and secondary care. Hospitals will compete for patients to generate revenue. A few will be very successful, causing PCTs to overspend. However, a few PCTs will play the commissioning game and some hospitals will indeed go bankrupt.

Increasingly this year the balance sheet will be the important thing, with services a poor second.

...And nice doctors

GPs will have to stick to the safety of the touchline but increasingly it will be a struggle to treat patients when parts of the medical armoury are sidelined.

We've seen glimmers this summer of closures and contracting services ­ the surgical college chief has stuck his neck out to suggest that the NHS cannot remain funded by general taxation for much longer.

I pointed out to a health editor recently that patients have no idea about the changes looming in health services. I'm not even sure many doctors bother with the detail either.

The health editor told me patients don't care; they just want a nice doctor to look after them. She may well be right. But we also live in a democracy ­ I don't recall anyone in May voting for ward closures and the shrinkage of frontline services.

Dr Andy Jones is a GP in Stamford, Lincolnshire

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