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Why STPs could spell the end of general practice

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Sustainability and transformation plans (STPs) being rolled over across England are set to reshape the general practice over the coming years. Would that be the end for general practice, or the dawn of a new era? 

It appears another reorganisation is inevitable

STPs as described by Mark Porter, chair of the BMA council, are an ‘aspiration’ and the BMA has found that £9.5bn will be required to launch them. Essentially, they are driven by financial accountability, based on an unrealistic optimism about future savings. NHS England seems to be in a hurry, running at least a five-year project in a year or two, with non-existent consultation with professionals and public.

It's a marriage of two debts (health and social care) to deliver cuts, rationing and opening doors for further privatisation of the NHS. To respond to a funding crisis by reorganisation is as at best foolhardy, at worst as grossly negligent, it’s rearranging the deck chairs on the Titanic. The speed at which changes are being made will not allow any evaluation of their effects or, indeed, for them to be implemented properly. They will, however, provide a smokescreen to hide rationing of healthcare and dismantling the proven model of traditional general practice from public view.

Most of the meetings I go to, I hear the CEOs starting their speech by talking of integration of health and social care as the ultimate panacea to solve the crisis in the NHS. They start emphasising the need to balance the books and to meet specific targets such as A&E access times. We need to move beyond the financial challenge to reach a point whereby general practice gains from this experiment rather than lose everything been so dear to profession and public for decades.

The meaningless 'top-down re-organisation' in the Health and Social Care Act by Andrew Lansley was a health policy disaster and has led to endless workarounds to achieve progress. History is repeating itself  The STPs are more fiction than reality. This is essentially a project by NHS England to supersede Mr Lansley’s act.

Why won't STPs work? Because every small change has to be negotiated and agreed in detail with all stakeholders before it can get the green light. The CCG, local authority, and NHS FT can veto any change. That kicks the entire project in long green grass. Any political interference to gain short-term votes can block change. Time after time, local managers are overruled by senior NHS staff to avoid political embarrassment.

And even if changes could be agreed locally, the funds and resources needed to deliver effective change is not available. So-called transformation money to fund STPs is spent plugging existing deficits. The iron rule of public service seems to have been lost: that you can spend the same money only once. NHS officials have come under intense pressure to produce plans that confidently predict the undeliverable, and most have bowed to that pressure.

It appears another reorganisation is inevitable (already happening with the impending demise of the CCGs). Changing health economies such as devolution in Manchester, integrated care organisations (ICOs) and the development of accountable care organisations (ACOs) is happening fast. My fear is this experiment too could end in tears like Lansley’s act. And in the process traditional general practice will end for good.

Dr Kailash Chand OBE is a retired GP and former deputy chair of BMA council. You can follow him on Twitter @kailashchandobe

This blog is part of our ‘Great GP Debate’ season. If you would like to write a blog on how you see the future of general practice, then please email the Editor at editor@pulsetoday.co.uk.

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Readers' comments (4)

  • 'The iron rule of public service seems to have been lost'

    Is that the rule that politicians will always bail out hospitals, so it is a moral duty to ensure unmet demand ends up in hospital as the only way to draw more funds into the NHS?

    (I'm not even sure if I'm being TIC... :-] )

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  • STP is more about cuts to services than anything else, in order to save £22 Billion. Hospital and community beds will be further cut. Many walk-in and A+E services will be closed and somehow, with no extra funds, GPs and social services, who are already grossly overstretched, will be expected to do more! We are heading for the complete demise of all high standards in the NHS. This is really the beginning of the end and the start of a third world standard NHS. But maybe that is the plan. Those that can afford it will be able to buy private services that will increasingly become available in what will, by then, be a new market. It will be normal for all, but the poor.

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  • For those who are struggling to understand what ‘Sustainability and Transformation Plans’ actually are, I have interpreted them into plain English as follows:

    Encourage working at scale
    CLOSE SMALL PRACTICES, DESPITE THE FACT THAT THEY ARE POPULAR WITH PATIENTS AND REDUCE ADMISSIONS.

    7 day opening
    STRETCH ALREADY OVERLOADED WEEKDAY SERVICES

    More care at home
    DUMP MORE HOSPITAL WORK ONTO GPS, INCLUDING VERY ILL, COMPLEX PATIENTS

    Enhanced multi-professional primary care teams
    NON-DOCTORS TO DO GP WORK, AND GENERAL PRACTITIONERS TO DO SPECIALIST WORK. NEVER MIND THE MASSIVE MEDICO-LEGAL IMPLICATIONS OF THIS

    Reconfigure acute hospital services to ensure efficient and cost effective
    CLOSE ALL BUT THE BIGGEST HOSPITALS, MAKE PATIENTS TRAVEL FURTHER, SEND PATIENTS HOME SOONER

    Encourage behaviour change eg. childhood obesity
    TRY THE SAME STRATEGIES WHICH HAVE ALREADY FAILED. FOR EXAMPLE THE ‘FIVE A DAY’ INITIATIVE HAS FAILED TO REDUCE RATES OF CANCER, AND OBESITY HAS IN FACT INCREASED SUBSTANTIALLY SINCE IT STARTED.

    Integrate mental and physical health care
    MANAGE MENTAL HEALTH PATIENTS IN PRIMARY CARE WITHOUT ADMITTING THEM, WITH THE HELP OF ‘THERAPISTS’ RATHER THAN PSYCHIATRISTS

    Integrated health and social care
    MAKE GPS RESPONSIBLE FOR SOCIAL CARE AND MAKE IT ALL COME OUT OF THE SAME INADEQUATE BUDGET

    Reduce system costs and pressure from unmitigated growth in demand
    FAIL TO MEET INCREASING DEMAND

    Efficiency saving to lead to break-even position by 2020/21
    REDUCE FUNDING

    Dedicated support for the most complex 0.5% and those near the end of their life.
    ENSURE THAT DNACPR FORMS ARE SIGNED AND LET THESE PATIENTS DIE RATHER THAN ADMITTING THEM.

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  • Anything that says 'end of general practice' should be auto corrected to 'end of NHS general practice'.

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