1st Feb 2011
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Dam Buster

News and Comment from Roy Lilley

Yesterday, just as we were going live, the PM's letter in the Times emerged.  As the paper is owned by you know who, and it is pay-walled there is no point in linking to it and as I don't want to spend the rest of my advancing years in court, we can't reproduce it.


However, we can comment on it.  In the letter the PM makes 6 basic points.  For starters he chastises the NHS for poor outcomes.  We are "behind the best in Europe".  Readers will know John Appleby from the King's Fund, gave that a good kicking over the weekend.  It is not true. 


The PM says he wants to improve patent choice.  As the great unwashed, like you and me, are obliged to register with one practice only, we will only be able to benefit from the care-pathways, treatments and locations that our practice's Consortia have agreed.  We have no input into that process and there is no legal requirement for the Consortia to make a place for a patient at the top table.  So that argument bombs.


Next, he tells us the GPs are gagging for it.  One hundred and forty one pathfinder consortia are hopping and skipping along the yellow brick road towards the blue horizon of a perfect future.  Er, apparently not.  We publish, today, the outcome of the Royal College of General Practitioners' survey of GP's views on the reforms.  It is the biggest survey, so far. If you are reading this in the DH or Downing Street, sit down and pour a strong cup of coffee. 


GPs are about two to one (sometimes three to one) against it and don't believe it will improve anything.  (More coverage in the Guardian).  So why are GPs joining up?  Pathfinders are GPs quickly getting into comfy groups with their mates before someone else dictates who they have to play with.  In some parts of the country they are trying to buttress collapsing PCTs.  In nearly all cases GPs are not trying to run pathfinders, they are creating PCT-lite, hiring other people to do it for them.


The RCGP survey could not have been more accurately delivered by Guy Gibson.  It is a Dam Buster.


The PM moved on to his next target; he tells us we have to cut the costs of bureaucracy.  Let's look at the facts.  Management costs in the NHS are about 5%.  In the US healthcare system they are about +25%.  In industry in general the percentage of management is about 16%.  In the NHS it is 13%.  There were 152 PCTs, now we are likely to have 200+ overlapping Consortia, meaning more management, not less.  All this is from a really interesting one-pager from Leeds University Business School.  Another prang for Downing Street.


Two final points in his letter; pharma prices are going up and there are more older people who will need treatment.  Neither of which the NHS can do much about.


In yesterday's lobby briefing the PMs spokesperson admitted he is running to catch-up. 


I can't find any bomb-proof reasons to blow-up the NHS.  MPs have voted for the Bill at the second reading.  I guess they just don't realise; NHS outcomes are in line, or as good as the rest of the world, or on a trajectory to better them.  Management costs are well within industry norms and could easily be reduced without destabilising the service.  There will be no improvements in choice as practices are bound to Consortia who are doing nothing more that PCTs used to do and there is already plenty of room to involve the private sector if the DH's  FAQs on AWP are to be believed. 


More important; they should look at the RCGP survey.  The Prime Minister has made much of having GP support.  It appears that is not the case and LaLa is running out of reasons.  Perhaps you should write to your MP and put them straight?


roy.lilley@nhsmanagers.net  Follow us on Twitter


9th-10th March London


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