Coalition Government NHS Reforms Disaster, Failure to Get GP Consortia's to Compete for Patients
Politics / NHS Dec 05, 2010 - 05:31 AM GMTBy: Nadeem_Walayat
The Coalition Governments NHS reforms to scrap ALL NHS Primary Care Trusts and replaced by competing GP Consortia's to directly manage the £85 billion budget for patient treatment commissioning, looks set to be heading for a complete disaster on the scale of the last Labour governments GP Contracts disaster, as GP Consortia's are being formed across the land on the basis of avoiding competition with one another.
The current system of patient health treatment commissioning is via the 152 Primary Care Trusts that manage an annual budget of approx £100 billion which the government aims to replace with approx 600 GP consortia's that Britain's 35,000 GP's are in the process of joining so as to have the responsibility for buying healthcare for their patients. The intention was for the new system to introduce market forces into the NHS with the result that failing hospitals would be allowed to go bust and similarly failing GP surgeries would lose their patients to better performing GP's / Consortia's.
Breaking the NHS Monopoly
There is no real competition in the current NHS system which demands reforms as the monopoly in healthcare operates right from the GP surgeries straight into hospitals to the detriment of patient health and tax payer funds, as Britain despite doubling spending in real terms during the Labour years still trails at the bottom of the European health leagues, even when compared with Eastern European health services that spend less than 1/3rd that which the UK spends on the NHS per capita. No Monopoly, whether private or state has ever provided competent deliver of services, which is why the Coalition government planned to reform the out of control NHS Healthcare state monopoly.
Unfortunately the coalition reforms appear to be on target to replicate the disaster of Labours 2002-2003 GP Contracts, as GP consortia's across Britain are forming non competing area bound Consortia's as illustrated by the example of City of Sheffield, as virtually all of Sheffield's 92 NHS GP Practices have signed up with one of of 4 geographically located GP Consortia's in advance of the implementation of the Coalition Governments NHS reforms.
- Central Sheffield Consortium
- HASC ( Hallam & South Consortium)
- North Sheffield Consortium for Health
- Sheffield West Consortium
The flaw in the organisation of geographically focused consortia's is to continue the current system of NON competing GP Surgeries for patients into non competing GP Consortia's which means that the governments planned pro market reforms will fail and patients could end up with even worse health services as GP's will be wielding far greater power within their geographic constructed Consortia's then they were able to wield under the city wide Primary Care Trusts, therefore no competition in GP services will exist and the reforms are destined to fail, just as badly as Labours 2002-2003 GP contracts failed, which instead of improving health care delivery, the GP contracts resulted in sending annual GP pay rises soaring into the stratosphere, culminating in pay rises of more than 30% per annum to stand at twice where GP Pay should be in terms of average earnings rises, whilst at the same time GP's cut back on hours worked and services such as out of hours services, a double loss for the patients and tax payers.
The Below graph illustrates the consequences of Labours disastrous NHS GP Contracts, GP's are now being paid TWICE that which they should be which also means that Britain only has HALF the GP's it should have. Unfortunately the coalition government will not cut GP pay in half and double the number of GP's. There is some chance that under the current reforms the government may seek to renegotiate the GP contracts in attempt to address the blatant abuse of tax payer funds, however the track record of governments coupled with the observed deviousness of GP's suggests that even more 'extra' cash will end up in the back pockets of GP's as a whole string of management fees are conjured up to swallow billions of the £85 billion Consortia budgets.
NHS GP's are clearly hoping to replicate Labours 2002-2003 GP contracts incompetence by seeking to block competition between GP surgeries, whilst at the same time gaining greater control over GP surgeries performance oversight via the Consortia's they are part of so as to continue self producing statistical data that does not match actual patient experience.
GP Performance as Measured by the Department of Health Funded UK GP Patient Survey
The Department of Health funded UK Patient GP Survey enables patients to bypass dodgy NHS statistics and find out the truth about their GP Surgery as per real patient experience. The UK GP Patient Survey 2009-10 recently released results of more than 5.5 million detailed questionnaires sent out to NHS GP patients across England, of which 2.17 million were returned. Patients can check the true performance of their surgeries here - http://results.gp-patient.co.uk/report/main.aspx
As an example of real performance of NHS GP Surgeries, the following are the Survey results for a local GP surgery - Darnall Community Health (Sheffield).
| % | |
| Overall Level of Satisfaction at the Quality of Healthcare received | 68% |
| Helpfulness of receptionist - Helpful total % | 75% |
| Ease of getting through on the phone - % Easy | 21% |
| Able to see a doctor fairly quickly | 41% |
| Doctor or nurse ever tell you that you had a 'care plan'? - % Yes | 14% |
| Ease of contacting the out-of-hours GP service by telephone - % Yes | 62% |
| Recommending GP surgery to someone who has moved to the local area - % Yes | 47% |
| Satisfaction with opening hours - Satisfied % | 62% |
| Last seen a doctor - % More than 6 months ago | 28% |
The results illustrate the disparity between official NHS statistics and actual patient experience, as virtually 1/3rd of the patients of the GP surgery are dissatisfied at the quality of healthcare received. Furthermore only 21% find it easy to get through on the phone, which means that many patients and especially men will have given up on trying to make an appointment because they are unable to even get through on the phone, which explains why official statistics are inaccurate as they may be missing out on as many as 79% of patients, many of whom won't be seen by a GP and hence will not factor into official statistics as generated by PCT's. Which also goes a long way towards explaining why 28% of patients have not seen a GP during the past 6 months.
However as many patients will experience, getting to a GP is just the first step towards getting an effective diagnoses and treatment, as patients run into road blocks and resistance all the way. First patients need to get their GP to take notice of the patients symptoms as GP's in accordance to the pay structure treat patients as ATM cards to swipe in and out of doorways so as to maximise profits. Therefore patients have to show much persistence of several consultations before the GP's take any notice of the patients symptoms, which means it could take as many as 6 GP consultations before a GP takes patients symptoms seriously, by which time several months or longer may have passed and along the way a large number of patients will have just given up.
And getting an accurate diagnoses is only the first step towards getting effective treatment.
Clearly where the current NHS system is concerned, there is NO concept of prevention, no concept of early diagnoses, no concept of early treatment, which is why Britain languishes right at the very bottom of European health league tables.
If the local example of Darnall Community Health is even half way typical of most NHS GP surgeries then that would imply that 10 million patients are dissatisfied at the quality of health care received, and as many as 20 million patients have difficulty in arranging appointments by phone, with similarly 20 million patients unable to see a doctor fairly quickly, and again 20 million would not recommend their NHS GP to anyone moving into the area.
Therefore not only does the total NHS budget remain out of control at £120 billion per year but actual patient experience does NOT match what amounts to NHS propaganda statistics, the reality for many millions of patients is that the NHS effectively does not even exist as they have long since given up on even attempting to gain competent diagnoses and effective treatment.
NHS Reforms are urgently required to prevent many thousands every year being sent to preventable early deaths.
Requirement for Competing GP Consortia's
Having non competing Geographic GP consortia's would be a recipe for disaster, as delegating powers to GP's without mechanisms for competition between GP surgeries for patients ensures that over time neighbouring consortia will seek to merge with one another thus reverting back to PCT sized consortia's, whilst these Consortia's will be virtually totally unaccountable to their patients, with total control now in the hands of city-wide non competing GP Consortia's, which would be a perfect monopoly solution for GP's that would be significantly worse than the current PCT system, which at least enables some independent scrutiny of GP surgeries performance to take place, rather than GP's being put in charged of monitoring themselves, with only lip service additional monitoring by local authorities.
Therefore for the Coalition Governments reforms not to fail then city wide consortia's should be created with the aim that there are at least 2 and preferably 3 competing GP consortia's per geographic areas. Thus in Sheffield's example, all four of newly established GP consortia's should be disbanded in favour of the creation of city wide consortia's that will enable patients to easily switch between the better and poorer performing GP's / Consortia's as the current system ensures that Sheffield's NHS GP Post Code lottery will just be further magnified due to lack of sharing of best practice which will become more concentrated in the better performing GP surgeries as the below post code lottery map illustrates (Sheffield NHS GP Post Code Lottery Map, The Best and Worst Ranked Surgeries )
NHS Privatisation Solution
Britains population has been conditioned over the decades to resist calls for the privatisation of the NHS. However, contrary to what the population believes GP's have always been Independant PRIVATE contractors to the NHS WITHOUT COMPETITION. GP surgeries are basically businesses for profit that operate with local monopoly powers over a captured patient population. The British population would not put up with any other monopoly but have been falsely led to believe that their GP is employed by the NHS when in fact is a private contractor. This fact completely defeats the argument put forward by the BMA which is the propaganda arm of Britains 35,000 GP's against private companies being allowed to deliver NHS services, which is what one would expect from those that seek to preserve their monopoly that allows outrageous profits to be generated at tax payer extent whilst patients are treated as ATM cards to swipe in and out of doorways.
Therefore coalition plans to hand over much as £85 billion per annum to PRIVATE GP Businesses that do not compete against one another would be a total disaster. The only answer to the crisis in the lack of productivity in the health services is for competition between GP surgeries and NHS hospitals which ultimately means FULL privatisation, as the existing system of no real competition means that lack of performance is rewarded with more resources in the face of inability to deliver whilst those that excel are punished with less resources so as to pull all services down towards the under performing mean.
The only way excellence can be rewarded and duplicated is if competition drives out of business the less competent GP surgeries as they lose their patients and resources to the better run GP surgeries which can only happen in a market orientated system of healthcare delivery, where patients would in effect be handed NHS heath credit cards to enable them to buy healthcare at ANY health facility whether NHS run or private.
Given the actual performance of the NHS, I would imagine that closing 15% of the worst performing NHS Hospitals and GP Surgeries would result in IMPROVED life expectancy for Brit's as well as contribute a £18 billion of annual savings to help bring the unsustainable £150 billion annual budget deficit under control rather than the existing Coalition policy of INCREASING the NHS budget by more than £20 billion.
Without mechanisms to drive the less competent hospitals and GP's out of business, then Britain's patients will continue to receive what amounts to a third world health service whilst paying a first world price.
The NHS Health Insurance / Credit Card
The NHS post code lottery which excludes millions from the best health care on offer can only be ended if there is real patient choice, not only for GP's but also hospitals and other health institutions right across the country where treatment is sought which requires real reform of the whole NHS health care system from diagnosis to treatment of all patients .
An important element would be to place the power to purchase healthcare in the hands of the patients by means of an NHS Health Card system, that enables patients to purchase health services from any GP practice or hospital regardless of whether it falls under the NHS umbrella or is fully private, with personal medical records encrypted onto the cards smart chips. Both patients and health practitioners would be fully aware of the financial transaction involved in the purchase of the health service, which is set against the current system where patients can be made to feel that they are an inconvenience so are easily put off by the practiced dismissive attitude of most GP's during the initial consultations, which means the medical condition of patients reaches a far more serious state and thus proves far more costly for the NHS to eventually treat.
The mechanism for the operation of the health cards could be by means of either an insurance or a credit based system.
Insurance System - An insurance system such as that which is successfully operated in Germany, where workers pay a premium as a percentage of their wages (average 14%, employer and employee paying half) into one of over 300 statutory state funds, that then cover the costs of healthcare. Patients can choose between insurance funds on the basis of premiums charged so competition acts to keep premiums competitively priced. Similarly patients are fully aware of their premium payments and cost of services thus demand a competent health service delivery. Those that are not working have their premiums paid for by the state. Additionally those with salaries above statutory limits can opt out of the state system and buy private health insurance.
Credit System - Patients would have a choice of covered core treatments for illnesses or injuries, where they would have the option of paying to top up treatments with their own money depending on the institution that they seek to purchase treatment from, or for other extra's such as IVF etc. This would have the effect of reducing the cost of the NHS whilst introducing greater efficiency into the NHS as the majority of patients would only choose those health service institutions that are ranked as delivering a good service. The NHS Health credit card would revolutionise the way healthcare is delivered in the UK, much as supermarkets revolutionised food delivery and choice during the 1980's, as heath supermarkets would spring up all across the country that would maximise efficiency and standardise quality of service delivery as they competed to offer a wider range of health services than anything a bureaucratic top down health care system could ever hope to provide.
The health care credit card system could be further enhanced by workers directly contributing to their health care plans that they can claim upon to purchase 'extra' services at a later date, much as workers today contribute into private pension schemes.
The impact of either an Insurance or Credit based system would be to greatly REDUCE the cost to taxpayers whilst at the same time delivering better health services as the focus would be on prevention to reduce costs, therefore a win, win outcome for the people of Britain as opposed the current system of an out of control unproductive £120 billion National Health Service that attempts to mask failure to deliver with phony statistics and propaganda of a "free for all service" that fails to match real patient experience.
Comments and Source: http://www.marketoracle.co.uk/Article24781.html
By Nadeem Walayat
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