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What are you – freedom fighter or terrorist?

Our GP commissioner blogger, Dr Clive Henderson, on the quest to liberate from central NHS control.

Liberating the NHS? Hang on, some of us didn't realise it was incarcerated. With BMA members considering a strike are they freedom fighters or terrorists? I guess it depends on your view of state control.

To me, the ethos of bottom-up, clinician-led change seems to be frankly buggered. It seems we must all now form ‘clusters', not in an organic non- prescriptive way but a ‘you-must-join-with- neighbouring-PCTs' way to share management structures. Is this the only way that the 300 emerging GPCCs could be shoehorned into keeping the NHS afloat whilst staff jump ship? Is it a move to encourage larger eventual consortia?

Back to central control again. What about the £400M of ‘extra' money to be pumped into cancer care. This is going to fund drugs with unproven clinical cost effectiveness. Is it a political decision? An attempt to bolster England up the international cancer survival comparator scores? A large scale trial to track down the holy grail of cancer cure? An experiment on a desperate cohort ? Trouble is it turns out the ‘extra' money is to be taken from PCTs existing budgetary allocations. My local PCT has just had to fork out £800K to contribute to this fund. It must be a nightmare for the financial directors juggling with unexpected diktats. I wonder what that money is now not going to buy? Patient transport services, IVF, bariatric surgery, carpal tunnel surgery… etc. Considering nearly half of lifetime health expenditure is spent in the last six months of life already, can we afford to keep actively ‘treating' to the end. One can always ‘treat' but is one actually curing, palliating or easing suffering in a cost effective fashion.

I am sure Macmillan could do great works with £400M, making for a better death and keeping people out of hospital.

I gather there has been an announcement about ‘extra' money for Improved Access to Psychological Therapies .( IAPT ) Wonder what is going to be cut for that then? Locally our IAPT programme has resulted in several months waiting time for an appointment which makes me wonder just how bad was access before? Furthermore there seems a service void between moderate misery (the upper limit of IAPT remit) and severe and enduring mental illness.

Back to state control. One way round this would be to seek democratic legitimacy by having the public vote for key positions. This is being proposed for police commissioners. I am sorry but I think it daft to expect the public to be able to understand the complexities of who would make the best chief of police. I bet many would vote for one called Sherlock Holmes or with a nice kind looking face. Likewise, what about the emerging consortia leadership elections favoured by LMCs. Not sure the average GP has a clue about who is best equipped to lead commissioning because they have not had chance to see the prospective candidates in that role. They might pick a jolly public speaker from the medic's golf club? Hope they don't pick on cosmesis because as shown by the fish eye lens photo of yours truly attached to this blog I'd be stuffed.

Dr Clive Henderson