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We are in danger of throwing the baby out with the bathwater

Our GP blogger, Dr Clive Henderson is worried the bill will be watered down too much to appease sceptics

http://www.pulsetoday.co.uk/practical-commissioningl

Our GP blogger, Dr Clive Henderson is worried the bill will be watered down too much to appease sceptics.

Poor Mr Lansley must be wondering if he about to be made a sacrificial wolf at the hands of an insecure deputy prime minister in search of potency. Mr Cameron may be tempted to appease his second-in-command and use him as an excuse for abandoning a policy he's got nervous about.

The policy risks becoming an ineffective corrupted chimaera of consensus while Mr Lansley tries to avoid being the scapegoat.

Price competition – in the original bill, but now crossed out - could have saved money vitally needed to support other areas of the NHS. At present if we are trying to make efficiency savings for something on a fixed tariff list we have to seek an alternative pathway , real or often quasi, denying some willing consultants the ability to do things more cheaply. Before people start banging on about cheaper being worse care then I should point out that it is up to commissioners to specify high key performance indicators ( KPIs ) for any contract to be awarded or maintained.

With respect to Mr Cleggs pledge re no ‘back-door privatisation' in NHS reform, perhaps we all need to clarify what the NHS actually is. A taxpayer funded system of societally sanctioned healthcare delivery which is free at the point of use. I think whoever or whatever can provide the best service to the patient and taxpayer should get the job and anyway , what am I ,as a GP , other than a private provider contracted to the NHS? Why is there a perception that independent foundation trusts , often perceived as ‘the NHS ‘, do not have a degree of self preservation and thus profit motive..

Obviously indiscriminate competition would be fragmenting and destructive but surely it is up to local commissioners to look at the services being provided and if a selected few fail on quality , location or , indeed, cost, then these need addressing. Firstly ,I would suggest frank and constructive dialogue and collaboration with the existing provider but if they were unable or unwilling to change then others should be allowed to enter the ring. Otherwise what leverage do commissioners have when the only choice is Hobson's. A prime example , given the current tariff system ,would be if providers were not able to switch procedures from a day-case to outpatient setting, the latter often carrying a substantially reduced charge.

I wish to applaud the Victoria Commissioning Consortium for having the bravery to trumpet their support for the reforms in this week's Telegraph.

http://www.telegraph.co.uk/comment/letters/8505479/Coalitions-GP-health-reforms-have-the-support-of-doctors-responsible-for-seven-million-patients.html

This may be perceived by many as against the current tide. However, there is much in the bill to be applauded. The greater integration with social services and clinically led commissioning being just two of them. Some elements seem unnecessarily Draconian , such as the hasty abolition of PCTs. Local determinism has saved us here in that our PCT staff are almost universally appreciated and obligatory redundancies are not on the cards. Having said that one has to guard against institutional recidivism and ensure the old guard behaves in a new way.

Another example is removing practice boundaries , specious because whilst having the seeming attraction of choice and competition ( see above ! ) it will bring with it waves of unwarranted hospital admissions from a visiting service which is separate to day to day general practice. Yes , I know there will be a chorus of hypocrite from detractors !

So with respect to Mr Lansley's proposals , please don't throw out the baby with the bathwater or dilute it to such an extent that the baby drowns.

Dr Clive Henderson is a GP and chair of Goole, Howden and West Wolds locality commissioning group

Dr Clive Henderson

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