By Ian Quinn
Health secretary Andrew Lansley has revealed all top-down reconfigurations of GP services into so-called polysystems are to be scrapped, as he brought plans spearheaded by former health minister Lord Darzi crashing to a halt.
In a dramatic reversal of PCT-led moves to shifts of huge amounts of hospital care to GPs, Mr Lansley said the halt to plans for 100 polyclinics in London and the re-organisation of GPs across the capital, revealed on Wednesday, was just the start of a major rethink of policy under the new coalition.
The announcement came as documents based on a secret report by American consultants McKinsey revealed NHS managers had vastly overestimated the ability of polysystems to handle the shift in care from hospitals and revolutionise GP care.
The documents, released by NHS London after being kept under wraps for months, reveal that the changes brought about under the hugely controversial Healthcare for London plans, including the opening of seven polyclinics in London since April last year, have actually cost far more money than they have saved.
The resources in reality, the report reveals, did not exist to support the hugely ambitious scheme
‘While some polyclinics have opened, the current moderate shifts of care out of acute have not yet transformed out-of-hospital care,’ the report says.
‘Current projects (eg stroke, trauma) have not yet been “cash –releasing” and instead appear to be leading to “additive” costs rather than reconfigurations,’ it goes on.
‘Similarly, although hospital admissions have started to stabilise, they have not dropped to the extent expected.’
Yet NHS London had pinned its hopes on more than 100 polyclinics and the resultant polysystems of GPs being able to cope with a massive 55% of outpatients care and 60% of care from A&E.
‘There is some mismatch in ambitions,’ says the report. ‘The capabilities to support large scale change are not yet fully in place.’
‘There is frustration with the overall pace of change and frustration at large number of small initiatives rather than fewer transformational initiatives.’
The original Darzi vision, it says, had been ‘diluted’, concluding: ‘Significantly, the core principles (and expected savings) of polysystems have proven difficult to achieve with more focus on the buildings rather than the changes to care and behaviours.’
Mr Lansley said he was ‘fulfilling the pledge I made before the election to put an end to the imposition of top-down reconfigurations in the NHS,’ having told Pulse in March that the Conservatives would tear up the Government’s plans.
Yesterday he said: ‘’We are committed to devolving power to local communities – to the people, patients, GPs and councils who are best placed to determine the nature of their local NHS services. Local decision-making is essential to improve outcomes for patients and drive up quality.’
Future plans, he said, must have support from GP commissioners, be based on sound clinical evidence and focus on improving patient outcomes.
‘A top-down, one-size fits all approach will be replaced with the devolution of responsibility to clinicians and the public, with an improved focus on quality.
‘It will be centred on a sound evidence base, support from GP commissioners and strengthened arrangements for public and patient engagement, including local authorities.’
Meanwhile NHS London has admitted that a finalised McKinsey report will now never happen.
The documents, which had been kept secret despite repeated demands from politicians and health campaigners , confirm that NHS chief in London had planned massive cuts in primary care, despite the focus on polyclinics bailing out the hospital spending crisis.
The documents reveals plans to:
• Reduce the average appointment time by 20%, allowing GPs to ‘spent more time where it is needed’
• Plans for nurse practitioners to handle up to 50% of consultations (as opposed to 33% currently)
• Reduce spending in primary care spend of by 2016/17 by up to £1bn
• Up to 30% of outpatients services to be de-commissioned altogether.
A spokesperson for NHS London said: ‘NHS London recognises that it is time to draw a line in the sand and make the study public.’
Lansley orders halt to all Darzi plans