NHS reforms will fail unless GPs get behind them: The Patient from Hell urges GPs to get involved in implementing the reforms as he considers what 2013 holds for healthcare.
The year 2011 was the year of sound and fury, as the health bill staggered drunkenly through parliament, attacked on every side. 2012 was the year of planning the reforms enshrined in the new act.
And 2013 will be the year of implementation, when it will be revealed whether the planning has been sufficiently rigorous or whether the act is fatally flawed. It will be a year when everybody will have to work incredibly hard and incredibly smartly, to get it all up and running, with unparalleled levels of co-operation between clinicians, administrators and ancillary services.
Any fool can lay down grandiose plans in a back room, but it takes real streetfighting determination and low cunning to implement anything, let alone something as all-embracing as the NHS reforms. Just look at what has to be done. Healthcare and social care has to be merged, with all the organisational and cultural shifts that will entail. Other qualified providers – charities and the private sector – will be given more chance to compete for healthcare services.
Patients are to be given a louder voice – I hope – as Links are transformed into Healthwatch and incorporated into the Care Quality Commission. Information (meaning data held electronically) is to be at the heart of the integration of health and social care. Patient records are to become pervasive, and, hopefully, accessed by the patients themselves.
To give body to these reforms, CQC, Nice and Monitor are planned to extend their roles into social care. New health and wellbeing boards and clinical senates are to bridge health and social care. GPs are to submit to a first-ever MOT, the "revalidation" process. All this is revolution, not just evolution, and revolution is notoriously difficult to manage.
Then, at the centre of it all is the switch from PCT commissioning to GP commissioning. It is now only three months before the balloon goes up on the all-new GP-led NHS, when PCTs and SHAs will disappear. In April, all the "shadow" bodies, set up in 2012 are supposed to materialise into real live singing and dancing commissioners, whose writ will run across all of primary and secondary care.
But, as Richard Vize reported last month, only 8 of the 211 Clinical Commissioning Groups had been so far fully authorised. Twenty-six of the 35 so far processed had "conditions" placed on them and one CCG has requested its authorisation be deferred.
One of the main cause for "conditions" is that many GP practices do not seem to understand what their CGCs' plans and priorities are. One hears grumbles from practices that there is an "us and them" attitude from the CGC councils, and that there is a minority of GPs on these councils. It seems to me that ex-PCT bureaucrats are busy taking over the CCGs. More importantly, I get the impression that many GPs have not yet bothered to get their heads round the implications of GP commissioning. The National Commissioning Board has got its work cut out to authorise all 211 CCGs before April. One of my forecasts for 2013 is that it won't make the deadline. That could strangle the reform at birth.
Worried about what seems to me to be a lack of engagement by GPs, I consulted an article in Pulse magazine, on "What will 2013 bring for GPs?". I hoped to find something approaching a dogged determination to implement the new reforms if only for the good of the patients.
On commissioning, Pulse recognises the immense difficulties ahead, particularly the delay in authorisation, and the possibility of conflicts of interest between CCG boards and private healthcare providers. Pulse put the responsibility for success or failure on the management of the CCGs rather than the GPs themselves. I find this a bit odd, as I thought the whole idea was the CCGs should be the executive arm of the GPs, who would be calling the shots.
Pulse lists commissioning fourth in the things that will engage GPs in 2013. Funny that, I should have thought it would be the first. But no, at number one are changes to the Quality and Outcomes Framework , the DH's way of giving special payments to doctors for meeting targets.
At number five there are further complaints about squeezes in take-home pay and pensions. Number eight is a dispute about the payment of a quality premium to CCQs for meeting their targets on mortality rates, reducing hospital admissions and passing the "friends and family test". It is clear Pulse thinks that money, not reform, will be uppermost in GPs' minds in 2013.
At number two, Pulse is concerned "practices will be battling with online records and new IT systems". To provide test results online, offer access to medical records and start monitoring patients remotely, seems to be considered the most ghastly chore for 2013 and beyond.
If Pulse represents the views of most GPs, they seem to want to play little part in the immense tasks ahead of the NHS in 2013. The whole purpose of the Lansley/Hunt reforms is that the NHS should be run by GPs. If the GPs are just sitting on their hands, worrying about their pay and their pensions, but not making the revolution work then 2013, the year of implementation, cannot be anything less than a catastrophe. Guardian Professional.
The year 2011 was the year of sound and fury, as the health bill staggered drunkenly through parliament, attacked on every side. 2012 was the year of planning the reforms enshrined in the new act.
And 2013 will be the year of implementation, when it will be revealed whether the planning has been sufficiently rigorous or whether the act is fatally flawed. It will be a year when everybody will have to work incredibly hard and incredibly smartly, to get it all up and running, with unparalleled levels of co-operation between clinicians, administrators and ancillary services.
Any fool can lay down grandiose plans in a back room, but it takes real streetfighting determination and low cunning to implement anything, let alone something as all-embracing as the NHS reforms. Just look at what has to be done. Healthcare and social care has to be merged, with all the organisational and cultural shifts that will entail. Other qualified providers – charities and the private sector – will be given more chance to compete for healthcare services.
Patients are to be given a louder voice – I hope – as Links are transformed into Healthwatch and incorporated into the Care Quality Commission. Information (meaning data held electronically) is to be at the heart of the integration of health and social care. Patient records are to become pervasive, and, hopefully, accessed by the patients themselves.
To give body to these reforms, CQC, Nice and Monitor are planned to extend their roles into social care. New health and wellbeing boards and clinical senates are to bridge health and social care. GPs are to submit to a first-ever MOT, the "revalidation" process. All this is revolution, not just evolution, and revolution is notoriously difficult to manage.
Then, at the centre of it all is the switch from PCT commissioning to GP commissioning. It is now only three months before the balloon goes up on the all-new GP-led NHS, when PCTs and SHAs will disappear. In April, all the "shadow" bodies, set up in 2012 are supposed to materialise into real live singing and dancing commissioners, whose writ will run across all of primary and secondary care.
But, as Richard Vize reported last month, only 8 of the 211 Clinical Commissioning Groups had been so far fully authorised. Twenty-six of the 35 so far processed had "conditions" placed on them and one CCG has requested its authorisation be deferred.
One of the main cause for "conditions" is that many GP practices do not seem to understand what their CGCs' plans and priorities are. One hears grumbles from practices that there is an "us and them" attitude from the CGC councils, and that there is a minority of GPs on these councils. It seems to me that ex-PCT bureaucrats are busy taking over the CCGs. More importantly, I get the impression that many GPs have not yet bothered to get their heads round the implications of GP commissioning. The National Commissioning Board has got its work cut out to authorise all 211 CCGs before April. One of my forecasts for 2013 is that it won't make the deadline. That could strangle the reform at birth.
Worried about what seems to me to be a lack of engagement by GPs, I consulted an article in Pulse magazine, on "What will 2013 bring for GPs?". I hoped to find something approaching a dogged determination to implement the new reforms if only for the good of the patients.
On commissioning, Pulse recognises the immense difficulties ahead, particularly the delay in authorisation, and the possibility of conflicts of interest between CCG boards and private healthcare providers. Pulse put the responsibility for success or failure on the management of the CCGs rather than the GPs themselves. I find this a bit odd, as I thought the whole idea was the CCGs should be the executive arm of the GPs, who would be calling the shots.
Pulse lists commissioning fourth in the things that will engage GPs in 2013. Funny that, I should have thought it would be the first. But no, at number one are changes to the Quality and Outcomes Framework , the DH's way of giving special payments to doctors for meeting targets.
At number five there are further complaints about squeezes in take-home pay and pensions. Number eight is a dispute about the payment of a quality premium to CCQs for meeting their targets on mortality rates, reducing hospital admissions and passing the "friends and family test". It is clear Pulse thinks that money, not reform, will be uppermost in GPs' minds in 2013.
At number two, Pulse is concerned "practices will be battling with online records and new IT systems". To provide test results online, offer access to medical records and start monitoring patients remotely, seems to be considered the most ghastly chore for 2013 and beyond.
If Pulse represents the views of most GPs, they seem to want to play little part in the immense tasks ahead of the NHS in 2013. The whole purpose of the Lansley/Hunt reforms is that the NHS should be run by GPs. If the GPs are just sitting on their hands, worrying about their pay and their pensions, but not making the revolution work then 2013, the year of implementation, cannot be anything less than a catastrophe. Guardian Professional.
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