I have to commend the government and the Secretary of State for Health; it is a strength to do a U-turn if the idea is rubbish. But it’s better still to do a quick impact analysis before announcing a policy, and get it roughly right thus avoiding wasting so much time. Not to worry, previous governments have a poor track record too; Tony Blair was fond of forcing things through anyway, and Margaret Thatcher announced "a great victory" every time she did a U-turn and even gave a speech about "the Lady’s not for turning" (immediately before giving away massive concessions to Brussels).
So what do we expect to happen next?
To be fair, that’s anybody’s guess. GPs, especially GP partners, do make the best decisions because they have to live with the long-term consequences; they will still be around in 15 years when a person they didn't treat develops some awful condition and needs 24 hour care. Salaried GPs average 2 years in a single job and are less inclined to worry about the future, or the costs of care, and more inclined to follow the guidelines ("refer everyone for further tests"). GP partners in a GP Commissioning Group might keep health care costs low, but only if they are interested.
GP partners became GPs in order to deliver the very best health care to each individual patient. They didn't join up to look at numbers and forecast trends. They may be good at it, but it doesn't interest them (and most are actually terrible at it). So they will delegate to managers, and the managers will make decisions and think that it is their right to play god with health care, and nothing will change. There are so many ways we could have done this to achieve better results.
If Primary Care Trusts (PCTs - the organisations that decide how many of each type of treatment will be needed, so hospitals staff up and buy equipment) were made accountable to a panel of GP partners then PCTs would be a lot better at their job. This doesn't mean the GPs have management meetings every week, it means the GPs can say "you did a bad thing there, you're fired" or "by this time next year we want more of this", and then go back to their day job of saving NHS and UK taxpayer £billions.
Article comments
1 - Glenn Contrarian
Hugo -
Given all the problems you see with UK's NHS, would you rather have America's privatized system?
Something tells me I already know the answer....
2 - Hugo Minney
Hi Glenn Contrarian
You guessed right. We simply can't afford a system that costs $1 in every $6 GDP, whether it is paid for by government by higher taxes, or by individuals. We certainly can't afford a system where 40% of the money never goes near the organisations that provide healthcare - the figure in UK is closer to 13% (8% on Department of Health and SHAs, 5% on commissioning).
I think NHS works very well (last para page 1 - NHS embraces change). The problem isn't NHS, it's the ministers who come up with stupid suggestions and then take a long time to back down.
Politics out of NHS? That would be impossible. But at least let's do feasibility before announcing change!
3 - Dr Dreadful
Precisely because they constantly complain about it, the NHS is one of the institutions Brits most value. I appreciate it even more keenly now that I live in the US and have to deal with the labyrinthine complexities of private insurance. Sometimes I feel that one needs an accountancy degree here just to be able to deal with being sick.
American healthcare can be superb; it can also be an identical experience to the NHS, particularly with regard to its generous supply of apathetic GPs (family physicians), long waiting lists for certain types of surgery, and hours of hanging around if a visit to the ER is necessary. At either extreme, though, it comes at the price of being expensive and almost impossibly bureaucratic.
For all its faults, the NHS works rather well, particularly if one is in general good health and only needs to have occasional contact with it.
As far as I know, doctors also still make house calls, which is unheard of in the US.
I've been over here for ten years and still can't quite get used to the concept of having to pay for a visit to the doctor's office.