Competition between healthcare providers was first introduced by the Tories in 1991.
In 1997 the incoming Labour Party changed this while keeping the division between purchaser and provider. Competition was played down in favour of co-operation, but were the interests of patients really at the centre of decisions? Something is clearly wrong when PCTs have plenty of unused community capacity and yet brimming acute trusts are in bed-management chaos.
As the population gets older, management of chronic conditions becomes more important. Payment by Results drives down follow-up pricing in a crude way that makes quality care uneconomic. And yet the high cost of new outpatient appointments has proved an ineffective force, as numbers have soared. It seems current pricing tools have had their day and we need a new model. That said, introduction of the market did make GPs realise just how much drugs and admissions cost, which was a much-needed lesson.
Patients need to be offered appropriate services a la carte rather than just the ‘treatment of the day'. This has been embraced by both social care and the NHS to a small degree with personal budgets, which are a step in the right direction. Patients won't have the benefit of clinical experience in these situations, but GPs could advise on purchasing decisions.
The NHS should learn from retailers, which understand their customers' needs and become more profitable by looking after them better.
Look after the patients and the pounds will look after themselves.
Dr John Havard
Saxmundham, Suffolk
