Monday, 18 October 2010

The absurdity of the NHS internal “market”.



A while ago one of the team flew a sortie to another part of the UK for a meet with fellow comrades from grunt school some of whom had come from other countries. As with all reunions it is a time for catch up, compare and contrast individuals’ experiences and consume a few naturally fermented organic chemical containing beverages.

Specialities tend to congregate and after a while the conversation turned to GP commissioning and what was happening locally. What was interesting was the compare and contrast element against a worldwide background.

One of the squad told us that in their patch a Darzi practice, paid for from the public purse to benefit the private sector had been so “successful” that it had been told to stop “treating” patients. Others said that those Darzhole practices on their patch(es) were being terminated due to the fact that they cost more than local GPs but then the lawyers became involved . . .

Despite the fact the collective IQ at this point was in the thousands, the individual blood alcohol levels were well above local legal driving limits, everyone had a Homer Simpson “D” word moment as these issues were discussed. A heated conversation followed and there was a diverse nature of opinions about this situation, always the case when more than 2 doctors meet and talk especially when they were from different specialities and parts of the world.

One group said this made no economic sense for although a Darzhole centre was successful it was public money paid to the private sector and the private sector should be exploited to the full.

Another group said can you imagine if this was McDonalds who had opened a new restaurant that had exceed targets would they shut it down? Hell no they would chuck more money at it and milk their success.

A third group (way?) said this is the current NHS “market” whereby contracts operate within the framework of the alleged free market but the NHS commissars who administer them are former Soviet Bloc Party driven target obsessed commissars who cannot see that what they have done is a) successful b) an efficient use of public funds and c) that by their actions and inabilities they are actually denying patients healthcare which is what they are charged with to provide and were actually meant to provide as comrade commissar NHS “commissioners”.

There was a lot of input from those overseas saying that they wished they were in that position for they could use the increased success to improve capacity and therefore income while increasing the provision of service to patients albeit at a price. There were also a lot of opinions at this stage of the evening that were unprintable.

This led onto a discussion about GP led commissioning as proposed by the current Party(s). Fine in principle, the alleged free market one, but if applied against the background of a (failed) Soviet styled centrally fixed price market and heaps and heaps of paper shifting between bureaucrats as opposed to hands on patient care will generate what exactly?

The same but different?

Will the White Paper improve things or will it drown us as GPs in a sea of mountainous bureaucracy while denying us seeing any patients? The overwhelming opinion based on this discussion is that it will.

It is like trying to break the 100m spirit world record while wearing leg irons. However much you talk it up you will never succeed under the current rules of engagement.

But then it will all be the GPs’ fault won’t it?

The market. Certain elements are successful for example private medicine and McDonalds and then there is the NHS “internal” market.

Our patients tell us which they would like and also which one they actually get, and will get, as they tell us we currently have billions to spend (not).

Praise be to the Party for all new NHS reforms. We are lucky to have once again met up with our colleagues from grunt school. The debate will continue. And what of patient care?

Whatever. Politicians come, bugger up the NHS, and go. Doctors and nurses pick up the pieces time and time again. It will be no different this time.

1 comment:

Muhammad Shoaib said...

An interesting discussion is worth comment. I think that you must write much more on this topic, it may well not be a taboo subject but typically folks are not sufficient to speak on such topics. To the next. Cheers
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