When the great war of NHS liberation was declared we were told that this would not be a top down reorganization. A certain Mr Cameron even said 'We are not reorganising the bureaucracy of the NHS, we are abolishing the bureaucracy of the NHS.'
Which bit did we miss about the non top down reorganization of the health service combined with the abolishing the bureraucracy of the NHS?
True a few managers have been made redundant locally but not nearly enough and those most incompetant survive to continue to wreak havoc and do remember this is one of the few local Soviets where all local NHS Commissars have either a Harvard or Yale MBA in contrast to those who failed in the too thick to fail comprehensive school system who as a result are found in most PCTs.
A small piece in the GP journal Pulse shows us how far the lack of top down reorganization is progressing. It says that cluster PCTs which do certain bits of NHS bureaucracy for the remains of the real PCTs who are still supervised by the Strategic Health Aurthority are now to be "outposts" of the new super uber quango the NHS Commissioning Board.
So the old system of
SHA > PCT > GPs
NHS Commissioning Board in parallel with the SHAs > cluster PCTs now NHS Commissioning Board outposts > PCTs > GP commissioning consortia > GPs.
So much simpler now don’t you think?
(If you want a laugh read the article in the link and you might even find a new word or more for the buzz word bingo card. Anyone know what commentarit means? Or is it misspelling of commissariat?)
Admittedly some bits will disappear at some point but we suspect in order for the Party not to maintain its top down control that most of the “change” or “reform” will consist of merely rebranding the same groups of incompetant bureaucrats but essentially keeping the same structures with different names.
Commissioning and the concept of an internal market is merely a bureaucracy based on a failed Soviet style state price fixed model of a market. All GP led commissioning is at present is rearranging the deck chairs on the Titanic while all the time the space being left to rearrange the deckchairs gets smaller and smaller as more top down reform via the new state organ the NHS Commissioning Board and its new “outposts” is implemented.
If the price is centrally fixed and all commissioning activity is to be controlled by the NHS Commissioning Board and its new "outposts" what role do GPs have in the commissioning process as the Party tightens its grip?
We almost forgot what our role is that of the fall guys. For who do you blame when GP “led” non top down reorganzation all goes horribly wrong?
The GPs of course but now with added consultant and nurse members.
Praise be to the Party for continuing to support the lack of a top down reorganization and for continuing to abolish NHS bureaucracy. Aren’t they doing well?
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Northern Doc was once a blog originally written by a group of GPs in Northernshire and expressed their experiences and frustrations of working in today's NHS. The pieces were compiled at social meetings after work and published anonymously in a once free society. Following the Government's Medical Council clamp down on freedom of thought, speech and expression by doctors and our belief that the views of a few doctors DO NOT represent the views of the profession as a whole their views will now be written by and published by a journalist who has previously contributed to the blog by virtue of social ties. Any inference that the word Doc means a doctor is now purely coincidental. This is as of the 22 April 2013.