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Building a new NHS will take time

How long does it take to achieve a revolution? Amid the rush to authorisation, and the ever-mounting workload from the day job, it’s easy for GPs to forget just how fast and how far the NHS has come over the past two years.

In the early days of the white paper and pathfinder consortia, it seemed almost inconceivable that the unprecedented reforms could proceed at anything like the breakneck pace Andrew Lansley had mandated. But while there remain huge questions over the implementation of GP commissioning – and nagging doubts among many over its rationale – there are now just five and a half months to go until the big handover. Across the length and breadth of England, CCGs are making do, learning as they go and trying to get to grips with the hideously complicated business of taking over from PCTs.

Against this backdrop, then, it might seem a little surprising that the most prominent cheerleaders of GP commissioning are choosing this moment to pour cold water on expectations. Last week Dr Johnny Marshall, former chair of the NAPC and now an adviser to the NHS Commissioning Board, warned it could take five years for most CCGs ‘to develop the necessary relationships and partnerships’. The NHS Alliance’s Dr Michael Dixon largely concurred. ‘It takes time to turn a tanker around,’ he said.

On the ground, many of the GPs who have volunteered to help steer that tanker would no doubt agree. Between managing shrunken budgets, jumping through the NHS Commissioning Board’s hoops and simply setting up their own infrastructure, CCGs are facing a formidable challenge.

Many are struggling even to meet the requirements for board membership, with some being forced to ‘share’ willing consultants and nurses. Some are wrestling with how to effect whole-system change while being given only limited power – as Dr Sam Barrell writes in our opinion section this week. And then there’s the small matter of trying to ‘engage’ a sceptical practice membership while simultaneously making real efficiency savings by cutting referrals and prescribing.

Achieving all that even in five years might seem optimistic – but the chances are, CCGs won’t get five years. Patience is a rare virtue in any part of Government, and in the NHS, perpetual upheaval has become a way of life.

Part of Mr Lansley’s determination to enshrine his reforms in legislation was to ensure they would survive a change in health secretary or even Government – but even he could not have forseen that he would have lost his post before they even began. And when his successor took the stage for his first big speech as health secretary at the Conservative Party conference last week the theme was, inevitably, more change, with a vow to ‘transform the culture of the system’.

GPs who are excited about the possibilities of clinical commissioning will fervently hope for patience from politicans. But even those who harbour grave doubts about the direction of the NHS reforms will be wary of any more wholesale reorganisation. For better or worse, CCGs are poised to start running the NHS. They must be given time to prove they can do so.

Readers' comments (4)

  • Good luck.

    Anyway,not to worry soon there will not be many GP's left to be performance managed -let alone ones to run the CCG's.

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  • Vinci Ho

    So , building a new NHS will take time .
    What kind of NHS will that be ?

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  • Slash and burn, destroy the NHS first then build it up again as a privately run enterprise to mirror Tory ideology in the image of US Healthcare - those who can afford it will pay, those who can't will die.

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  • "What kind of NHS will that be?"

    Based on the content of the Health and Social Care Act 2012, it will look a lot like Medicare in the USA. Most of us won't be eligible for much state subsidy so will have to take the alternative of buying cover for medical treatment costs through the private health insurance industry - once the personal health budgets system is in place and insurance companies have taken advantage of its transferability feature, there won't be much NHS money left to pay for treatment, on top of having to pay for running competitive markets for all procurement. So only basic treatment will still be available on the NHS from CCGs. Pro-privatisation think-tank reports (all commercially sponsored, of course!) have suggested that only A&E should stay free of charge in the long run. However it seems more likely that we will copy the German system and have CCGs offer a set of basic NHS-funded treatments which will still be available for people who lack insurance cover or the ability to pay the user fees and/or co-payments which will be a feature of the new system.

    CCGs are to be left to decide annually which services they can still afford to offer on the NHS, so the details will vary from CCG to CCG in the worst postcode lottery we've ever seen.

    What I don't understand is why GPs seem so sanguine about all this - have you not found those think-tank reports yet? Here's one worth reading:

    By the way - this is a from commercially sponsored organisation, which has no concern for patients or for equity, only for making sure its sponsors see that its influence has made them more money - so they keep on sponsoring the propagation of these skewed, dishonest and self-interested arguments.

    NB the Adam Smith Institute has been arging for the reform that is now happening - it has consistently made the same argument since 1984 - only now is it getting its plans implemented, and bizarrely, GPs have become its stooges in downgrading the access to decent healthcare for the people of thhis country!

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