If you live here in England, you’ve probably noticed that the government has decided to give £80 billion of public money to GPs (read: private companies working with GPs) and scrap primary care trusts. David Cameron claims “We are not reorganising the bureaucracy, we are scrapping the bureaucracy.”
One of my biggest problems with the NHS is that the bureaucracy of the health system is incredibly unwieldy. All too often the left hand doesn’t seem to know where the right hand even is, let along what language it speaks. I’m also usually in favour of devolution and the localisation of services. I can’t conceive of how this particular change will be an improvement though.
We currently have 150 primary care trusts (PCTs) and the government is proposing to replace them with between 500 and 600 GP consortia – in order to save money. Surely though the cost of doing this in the first place is going to be ridiculous?
Surely this move will do nothing to remove the NHS bureaucracy: it’ll just shift it from (publicly owned) PCTs to (privately-owned, but publicly funded) consortia. This will mean that thousands upon thousands of people working in admin will lose their jobs…and thousands of new jobs will be created elsewhere. It’s being claimed that individuals who currently work for a PCT could seek work with a consortium but…this is just stupid. Thousands of admin workers will basically be relocated to new bodies, and this is going to cost a huge amount of money: it’ll cost to close down the PCTs, it’ll cost to make redundancies, it’ll cost to advertise for the new jobs and to run interviews and to basically re-train pretty much all of the non-hospital admin staff for the NHS in England. What planet is Andrew Lansley living on?
Additionally, each PCT tends to have its own individual policies, guidelines, patient booklets and outreach/advertising schemes for various services. It costs money to produce all of this: surely it’s going to cost more money for 500+ variations on a theme than 150?
Okay, so suppose the government is right about how best to save money whilst providing better services on the NHS (hah!) and all of the above will be cancelled out by the long-term savings. How easy will it be to hold all of this hundreds of these new consortia to account?
A few days ago I posted up a new policy for trans name changes we’ve sorted out with the local PCT. Within three years that change is probably going to be a bit pointless, and I won’t be surprised if things regress within the Coventry area. There’s a lot of very decent GPs out there, but others aren’t: a bunch of them are bigoted arseholes who will deny treatment to LGBTQ people at the drop of a hat. If GPs are going to be responsible for deciding who gets funding and hospital referrals, trans people who seek medical treatment could be in a lot of trouble. I’m not just talking about trans people who want to transition medically: I’m talking about any trans person who wants any kind of treatment, since the whole “we don’t serve your kind here” attitude is still highly prevalent. Of course, under current rules the NHS as a whole in the UK has to provide treatment (including aspects of medical transition) for all trans people, but that hasn’t stopped certain areas (such as, say, Wales) from refusing to provide treatment.
Right now, if we’re lucky enough to have the PCT on our side (as we finally do in Coventry…tentatively, at least) then we can have them pressure the GP to sort it out. This system is far from perfect, since many PCTs simply don’t want to listen (see: Oxfordshire) but I imagine it’s going to be far harder to bring about positive social change in five or six local consortia than it is with a single PCT.
Moreover, one of the biggest problems with the NHS is communication. One of my friends was given a referral to Charing Cross gender clinic by a psychiatrist after years of waiting, but then had to move house and ended up in a different PCT. The PCT refused to acknowledge the referral and made her start again from scratch, effectively postponing her access to hormones by two years. I can’t imagine that this kind of thing will be less common with the NHS split up into more bodies.
So what can we do? Well, I suspect there’s very little we can do, but now is the time to act. We should be fighting on every front: writing to politicians, talking to the media, participating in protests and taking part in any consultation event we can find out about, and at every stage we should be asking awkward questions about how these changes will impact minority groups such as trans people (‘cos I’m pretty certain it will disproportionately screw over others, such as people living in poorer areas).
Finally, a couple of thoughts from The Guardian:
GPs are doctors, not accountants
We need to get some meeting arranged so a few of us can look into this and gauge where things might head…. I strongly suggest Ben Thom as well as he has a handle on stuff although he isn’t too well at the moment…
You’ve basically called it right, I suspect.
GPs are just not equiped to do all the work of a PCT, and the cost of these additional services would be lower if they were provided for larger bodies. So what I believe will happenin practice is that the GP consortia would group together into larger local organisations, that will hire a third party company of advisers, managers and services.
The biggest problem however is doctors themselves. There are three reasons that someone goes into medicine – power, money and helping people. These new GP consortia will need GPs to have management skills. Those best at management tend to have political minds. And people who want to help people often don’t specialise in politics…
In some ways the NHS could be made somewhat better by splitting it up into smaller parts, but then it could possibly be made better by pulling parts together to form a larger whole.
I remember my own GP woes when I was in another part of the country. Being not just refused treatment, but any and all treatment being actively blocked as much as the GP could manage.
These nightmares happen now, today. And they will only get worse as GPs become more and more unaccountable.
Although I’m extremely concerned, I don’t think these changes *have* to be bad. If there were sufficient safeguards on a national level and some way of keeping the new local consortia owned by the public or charities, it could work out. Sadly I think that Tory ideology rules out both of those possibilities.
but we all know the free market and private enterprise are the solution to every single problem, and they’ve never done any wrong ever and never will…
I think that MPs, heck, everyone involved in government, should be forced to take the public option only.
Public transport, NHS, and so on. Maybe we’d see some well thought out reform. Maybe we’d see some rushed, ill thought out reform too, but it’d be an interesting experiment to run at least.
You know, when I heard they were scrapping PCTs, I thought great! No more postcode lottery, no more bureaucratic bullshit when you move house, obviously this will mean healthcare behaves more like a bank in that you can visit any doctor in the country and get the same service as if you had visited your local.
Just goes to show I shouldn’t leap to conclusions =(
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