NHS GP's Engaging in Smoke and Mirrors Battle Over Control of £80 Billion Health Budget
Politics / NHS Apr 04, 2012 - 01:38 AM GMTBy: N_Walayat
Mainstream press commentary gives the impression that there is a battle taking place between GP's who are either for or against the Coalition Government reforms for the transference of annual NHS commissioning budget of at least £80 billion into the hands of GP led consortia's across the country.
The reality of the situation is that the reforms have been already implemented in all but name as consortia's have been set-up and PCT's have been wound down with staff in large part transferred over to the GP consortia's. Therefore the battle taking place in the media is mostly smoke and mirrors, as the real battle is between those GP's who acted early to create and manage the consortia's and thus gain control over the NHS budget against those GP's who failed to act who have been left out of the loop and who are now fighting to secure a share of the NHS budget pie, therefore the battle taking place is nothing more than vested interests attempting to gain financial concessions from the newly created GP consortia's.
Flawed Government NHS Reforms
The government's NHS reforms are fundamentally flawed as I have been illustrating at length since they were first announced over 18 months ago in June 2010 (09 Jul 2010 - ConLib Government to Give NHS GP's £80 Billion Blank Cheque), and which the mainstream press only been became aware of to limited extent during 2011. The problem at the root of the NHS government reforms is that they do not address the fundamental flaw in the NHS that is there is NO COMPETITOOM FOR PAITENTS. NHS GP's operate as monopolies which is why approx 1/3rd GP practices can get away with failing to deliver GP services to the satisfaction of patients year in year out without any consequences for there are none for failing to delivery due to the fact that there is no market for patients.
Sheffield NHS GP Consortia's Example
The core at the heart of Coalition Government's NHS reforms is to scrap ALL NHS Primary Care Trusts (PCT's) to be replaced by competing GP Consortia's to directly manage patient treatment commissioning.
Unfortunately whilst the propaganda is of better value for money by means of competing consortia's, however the implementation of the reforms is proving to result in the exact opposite anti-competitive consortia's, as virtually all of the Sheffield NHS 92 GP Practices have signed up with one of of 4 geographically located GP Consortia's.
- Central Sheffield Consortium
- HASC ( Hallam & South Consortium)
- North Sheffield Consortium for Health
- Sheffield West Consortium
The flaw in the construct of the consortia's is that there is nothing to suggest that the consortia's and GP surgeries will be competing for patients which therefore means the governments planned reforms will fail and patients could end up with even worse health services as GP surgeries will be wielding greater power within their geographic constructed Consortia's then they were able to wield under the city wide Primary Care Trust, therefore no competition in GP services will exist and the governments reforms are destined to fail just as badly as Labours 2002-2003 GP contracts failed as they sent annual GP pay rises soaring into the stratosphere, culminating in pay rises of more than 30% per annum.
The NHS GP reforms being implemented are pushing towards the worst of both worlds, i.e. no market competition and unprecedented GP control over NHS funds that in significant part will be funneled into the back pockets of NHS GP's as the below excerpts of my analysis during 2010 concluded and warned the consequences of:
05 Dec 2010 - Coalition Government NHS Reforms Disaster, Failure to Get GP Consortia's to Compete for Patients
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.
14 Nov 2010 - Sheffield NHS GP Consortia's Are Anti-Competitive and Should be Scrapped
The core at the heart of Coalition Government's NHS reforms is to scrap ALL NHS Primary Care Trusts (PCT's) to be replaced by competing GP Consortia's to directly manage patient treatment commissioning (the process could take 2-3 years to implement).
Unfortunately whilst the aim was for better value for money by means of competing consortia's, the implementation is proving to be resulting in the exact opposite anti-competitive consortia's, as virtually all of the Sheffield NHS 92 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.
The flaw in the construct of the consortia's is that there is nothing to suggest that the consortia's and GP surgeries will be competing for patients which therefore means the governments planned reforms will fail and patients could end up with an even worse health services as GP surgeries will be wielding greater power within their geographic constructed Consortia's then they were able to wield under the city wide Primary Care Trust, therefore no competition in GP services will exist and the governments reforms are destined to fail, just as badly as Labours 2002-2003 GP contracts failed as they sent annual GP pay rises soaring into the stratosphere.
01 Oct 2010 - BMA, NHS GP Doctors Do Not Want Competition, Value for Money or Patient Choice
The British Medical Association (BMA) representing NHS GP Doctors has belatedly gone on the offensive against the coalition government's plans for reforming the NHS by introducing a market for competing GP consortiums to manage most of the NHS £100 billion budget. NHS GP's do not want competition because it would mean a more commercial health service where patients are able to freely move to the better run GP surgeries which risks putting failing GP surgeries out of business and fellow GP's out of work.
Therefore under a more competitive GP health servicing market as consortia compete against one another for patients, those surgeries that rank at the bottom that prove unable in satisfying and thus retaining patients, should find themselves forced to merge and to restructure with new staff employed so as to ensure that the consortia's are better able to compete against one another for patients. This also means for the reforms to work then there must be at least 2 competing consortia per locality, and preferably more other wise the reforms will FAIL and result in even worse patient health care experience as there will be NO incentive for GP's to treat patients but every incentive to deliver as much as possible of the £100 billion NHS budget into the back pockets of GP's which is probably what GP's expect to happen as occurred following the 2003 Labour GP contracts as illustrated by the below GP Pay graph that contributed to the 2009 MP expenses scandal as GP pay took off into the stratosphere whilst MP's watched on in envy therefore triggering the expenses abuse.
09 Jul 2010 - ConLib Government to Give NHS GP's £80 Billion Blank Cheque
The ConLib government appears hell bent on repeating Labours 2003 GP Contracts mistake by effectively giving GP's a blank cheque that is expected to result in huge pay rises as GP's take money meant for improving patient healthcare to reward themselves for working less hours.
The Health Secretary Andrew Lansley believes GPs are best placed to understand patients' needs and to decide where money should be spent by funneling as much as £80 billion of the annual NHS budget to groups of GP practices to decide what healthcare services would be purchased for their patients, however the last Labour government tried a similar exercise of empowering GP's that resulted in the exact opposite outcome of that which was intended.
Labour GP Contracts and MP Expenses Lesson
When Labour came to power in 1997 average MP pay was £43,722 against average NHS GP pay of £44,000, so both were inline with one another at that time. However as the above graph clearly illustrates in 2003 something started to go seriously wrong with GP Pay which took off into the stratosphere as GP's decided to award themselves pay hikes of more than 30% per annum at tax payers expense that has lifted average GP pay to £130,000 per annum against £64,000 for MP's.
Private GP Super Surgeries Maximising Profits
The privately operated super surgeries illustrate the flaws in the whole NHS strategy that lacks the fundamental key missing element of competition for patients between GP surgeries as my analysis of what patients can expect to experience in reality from Sheffield's Super Surgery operated by the One Medicare set against that propagated by its glossy leaflets which illustrates the danger of letting the private sector contract for the NHS as without competition for patients between GP Surgeries then there is no incentive to deliver satisfactory GP or any other health services as monopolies will seek to maximise profits such as by cutting costs by contracting locum's who lack authority to deliver what is in the best interests for patients.NHS GP Doctors Putting Profit Before Patient Care, Channel 4 News Investigation
During 2011 a Channel 4 News investigation charged NHS Doctors with the subversion of the the coalitions governments NHS reforms to result in NHS doctors pocketing all of the cash saved as a consequence of the NHS reforms, which matches my own analysis of a year earlier that the Coalition Governments proposed reforms were fatally flawed in that they allowed GP's to profit from patient care.
"Your doctor making a profit out of your health care, your GP Sending you to a clinic that he or she owns shares in, we are seeing the biggest shake up of the NHS in its history, Channel 4 news can reveal tonight that there is nothing on the legislation currently before parliament to prevent the outcome no one wants, doctors putting profit before the care of patients, in our special report tonight we show how the new arrangements will create fundamental conflicts of interest potentially harming the trust at the very heart of the doctor patient relationship". Channel 4 News
Channel 4 News investigation key points:
- Serious flaws in the Governments NHS reforms legislation, it's failure to protect patients against fundamental conflicts of interest, it allows GP's to put profit before patient care.
- All of the monies saved will go into the pockets of NHS GP's and doctors.
- GP's during patient consultations factoring in the profit they will make on their diagnoses.
- GP's referrals on the basis of how much commission they will earn from the heath institution.
- GP referrals to health clinics that the GP's own shares in.
- New private health clinics being set up with a view to making profits so that they can floated onto the stock market at huge profit for share holding GP's
- GP's get access to dip their hands into the annual £80 billion pot of money meant for patient care.
- GP's draw up the rules themselves on the conflict of interest, akin to writing 100 times, "I promise, I will not fiddle the patients"
Under the previous Labour government patients were treated as credit cards to swipe in and out of door ways as fast as possible to maximise profits. Under the Coalition government patients will now become cash cows to milk to the fullest extent possible, what's best for the health of patients won't even factor into the thought process during GP consultations - "If I send Patient X to Clinic Y for Operation Z, my consortia will earn a commission of £2,000".
The NHS Health Credit Card Solution
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 into the hands of the patients by means of an NHS Health Credit 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, so that 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 are made to feel that they may be wasting the GP's time so are easily put off by the practiced dismissive attitude of most GP's during initial consultations, which means the medical condition of patients reaches a far more serious state and this proved more costly for the NHS to treat.
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 including 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 this would be to greatly REDUCE the cost to taxpayers whilst at the same time delivering better health services, 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 does not match real patient experience.
Source and Comments: http://www.marketoracle.co.uk/Article33950.html
By Nadeem Walayat
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Nadeem Walayat has over 25 years experience of trading derivatives, portfolio management and analysing the financial markets, including one of few who both anticipated and Beat the 1987 Crash. Nadeem's forward looking analysis focuses on UK inflation, economy, interest rates and housing market. He is the author of three ebook's - The Inflation Mega-Trend; The Interest Rate Mega-Trend and The Stocks Stealth Bull Market Update 2011 that can be downloaded for Free.
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