Comment

GPs at the heart of the new NHS

The new government's health reforms signal radical surgery for UK healthcare system says Ken Hesketh

The health white paper published earlier this month, Equity and Excellence: Liberating the NHS, put flesh on the bone of the government's stated intention "to increase democratic participation in the NHS with the aim of making it more accountable to the patients that it serves."

That is, it sets out the government's aim to hand over £80bn of NHS funding to GPs to buy care for patients in their area, with the 157 primary care trusts (PCTs) and 10 Strategic Health Authorities (SHAs) to be abolished by 2013.

It will mean "management costs" contained in these tiers will be cut by almost half and GPs could sub-contract work to private companies.

The government's stated objectives with its reforms are to cut waste and bureaucracy, ensure more money gets to the front line of patient care, and standards are driven up.

Although the NHS budget is "ring-fenced" by the government and will be spared cuts to reduce the public sector deficit, indeed the government wants to increase its funding above inflation for every year of this Parliament, the Department of Health (DoH) is still tasked with finding efficiency savings of £20bn this year.

Cameronian Conservatism

In order to balance these objectives, the DoH is seeking to bring in a number of new working practices that combine traditional Conservative thinking on markets, choice and competition with Liberal Democrat and Cameronian Conservatism beliefs of pushing democracy down to a more local level rather than the "top down" target-driven approach of the last government.

The government also wishes to give every patient the power to choose any healthcare provider that meets NHS standards, with NHS prices.

This encompasses independent, voluntary and community sector providers.

Cameron and Clegg are attempting to square the circle of keeping what is currently best about the NHS while at the same time transferring power downwards, increasing the number of providers and increasing efficiency.

The coalition is seeking to give patients more influence over decisions about their care, offering them the right to choose the GP they want regardless of where they live; rate hospitals and clinical staff according to the quality of care received; and take charge of their own health records.

At the same time, it wants to empower NHS staff through increased responsibility and greater control over how the services they run are managed and budgeted.

This increased power for patients was emphasised in the recent white paper: the patient is to be put at the centre of the health service and the sound bite "no decision about me, without me" is used as a theme throughout.

A new patient champion organisation called HealthWatch will also be established as part of the new super healthcare regulator, the Care Quality Commission.

With this in mind the NHS and other healthcare providers must prepare for a new system that welcomes transparency and accountability of efficiency and quality of services and seeks to ensure patient care does improve as a result of these changes.

The changes outlined in the white paper are also likely to mean streamlining of existing administration protocols within the healthcare system, with expectations that many processes will become digitalised and comparative information (by cost, convenience and quality levels) readily available online.

One of the objectives in this sphere is to make it easier for patients to download their records to share with healthcare organisations of their choice and allow doctors and patients to communicate via email.

This was already starting to happen but the white paper may have the effect of speeding up this process.

Public's expectations

This shake up of the NHS, based upon the principles of consumer choice, fits with the general public's expectations, as it is used to choosing its service providers based upon the quality of product and customer service on offer. Such criteria are currently routinely used by the consumers when choosing banking; insurance and utility service providers.

Such principles are applicable to health and wider care services but do represent a cultural shift from an existing, one size fits all, supplier mind set.

In the first authoritative poll since the General Election, Benenden Healthcare examined people's opinions on the suggested healthcare reforms, and found that there is a strong public appetite for more choice, more information and more control.

Change is inevitable as technological and scientific advances are being made all the time. The old structures, although delivering, on the whole, good care for patients, are nonetheless creaking under the strain of demand and technological change.

What is clear is that patients and frontline staff will need to recognise and accept that reform is on the way.

The next few years could see the largest shake up in the NHS since its creation in 1948. We must work together to ensure that this evolution of the NHS does not undermine its core purpose – to provide universal and quality healthcare for everyone free at the point of need.

• A full version of Benenden Healthcare's report into public findings on the Government's key health policy proposals is available here www.benenden.org.uk/healthpollfindings. NB this poll was conducted BEFORE the publication of the NHS White Paper

Ken Hesketh, is chief executive of Benenden Healthcare Society

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