Dark nights and darker thoughts.

For those of us who live North of the Thames the inevitable move towards autumn and winter leads to a rapid shortening of the daylight hours. Now darkness is good for members of the Resistance based at the infamous Café Michelle for it allows more covert activity and as the temperatures drop the thought of a night with good company and a few fermented fruit beverages is very appealing.

At one recent such meeting we were discussing the state of the current health and social care bill and what had been said at various meetings and events that members of the team go to. We are a very broad church here up North in terms of our interests and associations and as a result encounter a wide range of opinions and thoughts on matters political and practical. After a few fruit juices the thought processes sometimes deviate from true logic and what follows is one such deviation.

For those of you not lucky enough to live in the Shiteton PCT’s area of enlightenment you will not see the results of early GP led commissioning. Here GP commissioners have many fruitful meetings and are reshaping local healthcare by the minute as all our Harvard and Yale educated MBA PCT commissioners always start the meetings with the words:

“How can we help you master/mistress? We are here to serve your every whim for the betterment of your patients all praise to Andrew the great prophet and liberator of the NHS.”

We are so lucky but not many leagues away we are aware of the complete opposite where local Soviets are dictating the rules of who can commission what and on what terms and as a result nothing is happening. Equally we know of other Soviets and GP commissioning groups that are in between these extremes.

Historically Government does not like resistance and certainly the old Party did not like GPs for they did what the Party asked but the Party did not like having to pay for that. It is uncertain at present what the current Party’s true thoughts are regarding GPs but it is clearly engaged in a campaign of lies, sorry spin, about how much “support” there is for their reforms in all sectors of the medical profession.

Commissioning has failed expensively over the last 20 years but is being reborn and re-branded but this time with GPs nominally in charge of much larger scale commissioning by GPs than ever before. Previous attempts at commissioning failed in times of plenty while this time we are in a time of recession.

We are told that this will be no top down reorganization but it is clear that local initiative is set to be stifled by the new financial politburo call Monitor and clinically via the new uber super quango the NHS Commissioning Board and its regional under boards.

So if GPs get to play commissioning how many of their ideas will be allowed by the bureaucrats who failed to make commissioning work in its previous guises? The Party can fight any Clinical Commissioning Group (CCG) on two separate fronts to prevent successful GP commissioning. One front is via Monitor using financial constraints and if that does not work they can fail an idea on clinical, quality or outcome grounds with support from other limp organs like NICE via the NHS Commissioning Board.

Add in a recession and reduced funds by virtue of inflation combined with a hugely flawed process and GPs are now fighting on three fronts with no ammunition or weapons centrally provided and still having to do their day job as well.

It is possible that despite “best” intent we GPs may all be looking into the large toothed jaws of possible global failure except that this time the Secretary of State may be able to wipe their hands of their enforced failure for they can blame the GPs instead. Failing that a change of Party might do the same job and blame the GPs as well. Is the strangling of local initiative by centralized Party control part of the Liberation process? And from whom is the NHS to be liberated from?

So in the dark corners of a Northernshire cellar in front of a blazing fire we got to “the what if” stage and dark thoughts loomed large. If GP commissioning fails perhaps the benevolent Party would have to step in and take over via the (its) Commissioning Board and Monitor and maybe a few other central organs of control? The Press would have a field day and say GPs “couldn’t” and therefore “shouldn’t” run the health service.

Completely understandable if you have to fight a boxing match with both hands tied behind your back, wearing a blindfold to outfox your opponent who can see where things are going, with lead boots from local NHS management to facilitate your forward progression and the complete absence of any seconds.

The next step might be to rein in GPs autonomy and perhaps enforce a salaried service in order to control any clinical dissidents and at the same time reduce costs and recoup all the excesses of the failed CCGs. A new leader might be required to sort things out and take charge perhaps a more powerful than now Secretary of State?

The new leader might then be free to bring in the private providers to run things better and then employ them via corporate entities? We won’t mention the words dentist in our discussions on these dark matters for it has happened there already.

Could it be that the Tripartite healthcare policy has one aim and that is to reduce GP control over and involvement in healthcare? For if GPs cannot successfully commission can you successfully refer or treat patients as independent “self employed contractors”? The system would clearly then need “reform”. The thought processes got darker and darker as the evening wore on until someone said some time honoured magic words to rid us of our demons.

“Time please ladies and gentlemen of the Resistance haven’t you got nice surgeries to go to tomorrow morning?” Yes we have but dark thoughts will be with us as we see our first commuting toddlers and pensioners at seven thirty hours tomorrow as true beneficiaries of previous “market” reforms.

Then the alarm went off and it was time to get up and go once again. At least this weekend we get an extra hour and the next early morning might not be as dark, for a while longer.

Praise be the Party for always needing to reform things even if they work. Let us hope our dark thoughts were merely a bad dream.