There is widespread support for GP commissioning across the political parties and in the NHS itself. But such a major reform cannot be rushed
There are few subjects as emotive as the National Health Service. It is the ‘third rail’ of British politics. Not even Margaret Thatcher attempted any real reform of a system designed in the 1940s and based around the same state mega-bureaucracy that built D-Day landing craft.
But the task of reform is urgent. Growing demand fed by chronic conditions, new expensive treatments and increased longevity means the NHS faces challenges that demand new ways of working.
There is no doubt that Andrew Lansley’s Health and Social Care Bill will accomplish huge things for patients. No longer will decisions be made by distant, anonymous primary care trusts. General practitioners – often with a lifetime knowledge of patients – will be empowered to seek out and commission the best treatment.
Entire bureaucratic organisations will be consigned to the waste bin, freeing huge amounts of cash to be spent on care, not paperwork. The Health and Social Care Bill stands every chance of reinvigorating a system that has not greatly changed in almost 70 years.
All of which makes it even more important that the changes are not rushed. In a report published early in April, Policy Exchange recommended that the 2013 deadline for all GPs to form themselves into consortiums should be relaxed. We said this because we believe a longer timeframe for change to take effect will make the reforms deeper and better.
The research we did with GPs in Cumbria, where the new system has been trialled, shows that many like and prefer it. But others need to have hard evidence that the system will bring real benefits. Likewise, new and innovative providers from all sectors – public, private and voluntary – need more detail on how they will fit into the system. Without this information, there is a real danger that these organisations will lack the confidence to carry on – losing expertise and skills.
Another danger is that a headlong rush will mean greater timidity in reforms, leaving a system that looks a great deal like the current one, with PCTs surviving under a different name.
Change that is too rapid and does not take people with it also means that many consortiums are not being given the space to develop as they want to. Our research found that some had been pushed into large groups against their will.
Others are facing pressure to employ ex-PCT staff, whether or not they are the best people for the job. There is a need for solid data showing what is most effective so GPs can follow the best practice.
There has been widespread support for some form of GP involvement in commissioning across all political parties and across the NHS over the past decade. That would make the tragedy all the greater if the consensus were to be destroyed.
It also goes without saying that anything that risks damaging standards of patient care should also be avoided.
The three-month pause in the Bill announced by Andrew Lansley is a perfect opportunity for everyone involved to reflect on the old saying that more haste can mean less speed.
Neil O’Brien is the director of Policy Exchange
