Sunday, 9 October 2011

The internal market, NHS “competition” and a Yorkshire practice.

A few bloggers have posted on a practice in Yorkshire offering to do certain operations for their patients for a fee. It seems from this link that health minister Paul Burstow does not think this is on as he and his Party seek to make this more the norm than the exception. How could this come about given the NHS internal market and competition?

Well perhaps it is the result of the true free market as opposed to the NHS Soviet style market? We have commented before on how the only part of the Party’s fixed NHS tariff, the only bit of which you can compete on is quality, not cost, that can be negotiated is the price a PCT can pay a GP to do a job cheaper than a hospital can. This means if a GP refers a patient to see a dermatologist with a mole then the cost of seeing the dermatologist is the same anywhere in the fixed price but competitive internal market that is the NHS Tariff zone. So the Party fixes cost but you can haggle all you like on quality with a hospital only GPs can undercut the hospital tariff price system.

So in general practice you get used to get the situation where NHS managers deep in their bunkers notice that as people become more vain they want moles removing a few of which may be cancerous which are the only ones that NHS commissar managers think really need removing. So being some of the brightest remedial class graduates they think did not GPs used to do that once and more cheaply?

We will give GPs a few farthings to do something that the hospital would do for a couple of hundred sovs and that should save us pounds. So the local Soviet commissars do this and go into the playground to play commissioning games and using the NHS Soviet free market model they restrict the number of cases GPs can do to save even more farthings.

If any of them spoke to GPs instead of dictating to them they would realize that minor skin abnormalities are very common and NHS consumers aka patients pay bugger all for anything so they will use the system as much as they like. NHS consumers, sorry service users, are well used to the concept of the free market especially when it comes to health.

Furthermore if you agree for example that a practice can only do say 30 excisions a quarter and the practice can do that in 4 weeks then where do the others go? Local GPs say that they could do more for cheaper but targets are targets so there is no extra money for doing more work so referrals to hospital continue to go up.

Now if you have been in a remedial class for all of your life and are allowed to play at being God in a PCT then the idea that you can stop your betters having something really appeals to you and so NHS commissars fix the market a little more. Not only do they restrict the number of procedures GPs can do cheaper than the hospital they stop the patients going to a hospital as well. The supply of dermatological surgery in the NHS free market has now been capped by your local PCT but the demand has not and it is not being met.

So you tell all the boffs in your class at school that you used to throw paper balls and other things at to stop being doctors and operating and you also tell them to stop being doctors by referring patients because we are not going to pay you so there! We are so big and clever with it!

Result if doctors cannot treat patient themselves or refer them to hospital because the local Soviet says you can’t how do doctors get round the not being able to treat their patients?

Well this is where the NHS “free” market comes in for it will allow any willing provider to set up shop. GPs are mostly small businesses and if you spot a way to make more money and provide a service being denied by the NHS then this is where the free market can help. You are not allowed as a GP to charge your patient for any NHS care but if the NHS does not provide the care you could set up as a private company and offer a service to patients for a fee. So the “free” market using innovation comes up with a solution to the problem created by the Soviet style NHS internal and centrally regulated market.

Simples. And we are sure that there will be plenty more such innovation as the money becomes tighter like the noose of central regulation of healthcare reform and it is probably an entirely intended consequence that has sneaked out a little too early for political comfort. Not all such any willing providers will be GPs but anyone who can see a way to exploit shortcomings in current and forthcoming NHS provision.

We here at ND Central wonder what will be the next any willing GP or provider opportunity? The way the NHS “market” works means there will be some and if you have the money you can always get better and quicker treatment when the NHS fails to provide.

Praise be to the Party of continuing reform using the current tripartite vision for NHS provided healthcare of expensive market good, cheap socialized medicine bad.

Do not shoot the entrepreneurs for they are just playing by the rules of the game and some of them may well win and win well. Their wins will probably be at the loss of the as of now non-paying consumer our patients and their future healthcare and wealth and all the result of a highly flawed centrally imposed market that has failed for 20 years.

And it continues to do so. Reform of a bad idea does not make it a better idea and even the politicians don’t like the result of their endeavours.

No comments: