Sunday, 11 July 2010

Fundholding about to be reborn?

There would appear to be a change a coming in the NHS as we know it.

And the Daily Mail says this.

Oh no not another pay rise for doing nothing. How do GPs cope with being the most highly paid in the world? Possibly because our workload is amongst the highest in the world and about to increase as we take on another job in addition to our already many day jobs?

Now anything that keeps changing its name is usually worthy of a degree of scepticism.

Think “Health Authority” or “Primary Care Group” or “Primary Care Trust” or now “NHS Shiteton”. Same group of incompetent idiots doing the same job but hiding their incompetence behind ever changing names.

So the former idea of “fundholding” aka “practice based commissioning” aka “world class commissioning” will become whatever the new word is, or will be, possibly “federating”?

Let us consider a few basic facts:

1) The country is in deep economic brown stuff.
2) Although the NHS budget is protected, this does not mean it is going to increase which with inflation will mean effective cuts in all but name.
3) Commissioning in its various guises does not work, thus far, and we have had 20 years of it.

We hope these simple truths are self evident to our readers.

Ergo central Government will appear to decrease costs and appear to generate “efficiency savings”.

However central imposition of failed ideas will lead to local increases in costs to GPs/GP consortiums/GP Federations etc.

As GPs will then have to become managers this will lead to a possible reduction in GP availability. Alternatively they may employ private contractors to do this for them and there are locally people positioning themselves to do this and in doing so make a profit at the expense of the healthcare budget. Alternatively they will employ the redundant local NHS managers, at their expense, to run the local NHS budget.

Excellent - not.

We await the exact details but it will inevitably mean yet another reorganization as to how GPs and their staff work and more bureaucracy.

So given the current “market” theory why not suggest a change that makes GPs “responsible” for a budget and gives patients a “choice” but also makes the patient, “accountable” for their choices to someone they may just respect?

At present “the consumer” in the NHS, the patient, has no responsibility and can take themselves anyone within the NHS at no cost to themselves. If you are a nutter with no friends you have unlimited access to the current NHS “Choices”.

Why not introduce (new) GP commissioning (nGPC), notice the subtle rebranding of old ideas and words, whereby if a patient accesses a health service the local GP is billed from the patients own “share” in their practice’s budget?

If the GP feels that the patient’s choice is inappropriate, for their alleged healthcare need, then the GP can block the charge to their budget, and on behalf of the State, reclaim the cost of the service used from the patient?

That way the State would not be the judge on who spends the NHS’s money but the local GP would be and, because they know their patients, they know whether their patients accessing of healthcare was medically appropriate, or not, they could be judge and jury?

This might make patients think.

For example if you go away on holiday and forget your medication whose fault is that? At present it is the NHS budget’s fault and your drugs are replaced for free. Not a medical reason so bang £65.00 for an A&E attendance + cost of drugs to patient. Bet they won’t do that again.

If we as GPs tell asthmatics they can get inhalers on repeat prescriptions from us but instead they go up for a routine prescription for an inhaler from A&E at £ 65.00 a shot and a GP says no, you pay for that as it is available free from us, guess what might happen?

Maybe this form of commissioning might be more cost effective as people would be financially accountable for their own actions if they are not medically appropriate, but would be free to use the health service at no cost if they are genuinely ill?

We, as GPs, already do this when we read discharge letters from hospitals, outpatient clinics and accident and emergency departments so to tick a box saying “Practice pays bill” or “Invoice patient” (with extreme prejudice?) would be very little extra work for most GPs but such fun!

Instead of sharing our concerns and frustrations with our colleagues as we read our correspondence, "Oh no, Patient X has had their fifteenth inhaler from A&E this week" we could be sending them a bill and suggesting they actually get their asthma treated by us.

This was just a thought as we discussed fundholding as it was, the dismal failure of current commissioning and the (black) thoughts of things to come this week over a few medicinal beers at the Café Michelle.

Still, at the end of the evening, the thought of some ND Central’s prime NHS misusers’ faces on being told they would have to pay for the NHS and its services was well . . . priceless.

If only . . .

Praise be to the Party who appear to be starting a summer of many nights of the long knives.

And many nights of GPs reading long documents, meetings, reorganizations . . . all for the benefit of our patients?

Or for that of the Exchequer?

1 comment:

Anonymous said...

"If you are a nutter with no friends you have unlimited access to the current NHS “Choices”."

Actually, it's us nutters that don't have a choice, we just get whatever mental health team is foisted on us, whilst people with other conditions get to choose which hospital or clinic treats them.