Saturday, 22 May 2010

Health Policy: fundholding reborn per chance?

Yesterday the current UK coalition love in published their The Coalition: our programme for government.

Now normally we don’t have much interest in matters political but we thought we would have a read. To say we were disappointed would be an understatement but we are also waiting for next week’s financial review to see if certain white elephants in health care might be scrapped.

We thought there were lots of woolly ideas but little detail but one paragraph caught our eye.

It reads:

We will strengthen the power of GPs as patients’ expert guides through the health system by enabling them to commission care on their behalf.

You will notice the C word there. A return to fundholding anyone but of course commissioning is not fundholding?

Those of us old enough to remember fundholding realize that if this is devolved to practices, or possibly groups of practices, this will inevitably lead to the employment of more managers and administrators just as it did first time round.

However another paragraph reads:

We will cut the cost of NHS administration by a third and transfer resources to support doctors and nurses on the front line.

Sounds good doesn’t it?

We suspect that NHS administration might be cut but, just as with fundholding, and with rumours of GP practices getting individual “real budgets”, this “cut” will lead to GP costs rising as “resources are transfer to support doctors and nurses on the frontline”.

We love support on the frontline. It usually means more work dumped onto primary care for little, if any, gain or improvement.

These costs cuts will appear to disappear from the NHS budget.

Just as with the end of fundholding when all the fund managers and admin staff were redeployed it might be that all the “cuts” in NHS admin costs will be but smoke and mirrors and history will repeat itself but in reverse.

So will all the cuts in NHS administration by a third result in needless NHS managers and administrators being paid to do the same thing with a different name in General Practice?

Praise be to the Party for possibly reinventing the wheel. The future of the NHS is bright, the future is possibly coalition green?

Where is the patient in all of this?

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