On Wednesday (February 8) the coalition government’s Health and Social Care Bill reappears in the House of Lords for its report stage. The government have tabled 136 amendments described as ‘concessions’ – but calls to stop the Bill are growing.
However, stopping the Bill is problematic. Prior to parliamentary approval, the Secretary of State for Health, Andrew Lansley has driven ahead with changes which would be hard to reverse.
In our area, NHS Wiltshire (the primary care trust or PCT) is already being split into three Clinical Commissioning Groups (CCGs) which are run mainly by GPs. The North East Wiltshire CCG (or NEW) covers the area from Ramsbury to Corsham.
In other areas these CCGs are already (before they’ve been fully approved) setting budgets and commissioning health care. Doctors in Wiltshire took a little longer to decide how to divide the county up, but members of the three CCGs are now working with the PCT and executive directors of the PCT are assisting the CCGs with governance issues.
The PCT itself has made the 45 per cent savings in admin costs that Lansley demanded and from March 1 will be ‘clustered’ with the Bath and North East Somerset (BANES) PCT. The regulations have been changed so these ‘clustered’ PCTs can merge their budgets – it’s not yet clear how far the Wiltshire-BANES ‘cluster’ will be a merger.
The merged or ‘clustered’ PCTs will only last till 31 March 2013. They are not statutory bodies, but they could be taken to judicial review over decisions they take.
Further up the chain, the south west strategic health authority has already merged to become part of NHS South of England – stretching from Dover to the Isles of Scilly.
To get a new view of the coalition government’s reorganisation of the NHS, Marlborough News Online contacted Dr Huw Williams who was a partner in a Trowbridge surgery for twenty-nine years. He retired two years ago and now works two or three days a week at the surgery mainly in its specialist cardiology unit which he helped set up.
As he is not part of a CCG Dr Williams can give his views on the Bill as an experienced yet disinterested doctor.
Dr Williams’ main fear is that there is no evidence that the new system for commissioning will work: “I’m against GPs being given a lot of commissioning – I don’t think they’re any good at it. No one’s suggested getting train drivers to run a city’s transport system. Just because GPs are near to the patient it doesn’t mean they’re expert at commissioning services. It’s a delusion.”
He looks back to the experiment of practice-based fundholding, when some doctors showed responsible corporatism while others proved very poor at controlling funds and some “rogue doctors” flourished: “Commissioning groups with a hundred GPs? No way they’re all going to agree – let alone behave in a sensible way.”
Dr Williams is worried by the “inevitable conflicts of interest” as many GPs will be providers of services at the same time as they commission services – whether it’s Dr Williams’ cardiology unit or a surgery that rents space to therapists.
One of the things he fears most is political interference: “Left to the politicians you’ll get examples of people misunderstanding the difference between needs and wants. It’ll be decision-making by decibel – he who bangs the desk loudest gets results.”
However, he does think that part of the trouble the government now faces has come from the concessions Mr Lansley has made after his Bill was first paused for alterations and then savaged by the Lords. It was “tokenism”, he says, to add one hospital doctor and one nurse onto each CCG: “What on earth is she or he going to be doing? It’s a bit of a dog’s dinner.”
However, Dr Williams says that once you’ve decided on a way to operate, “The more you dilute the less chance you have of getting people involved who can make a difference.”
Government ministers have dismissed the recent high decibel opposition from GPs – from both the doctors’ union, the BMA and from the Royal College of GPs. They do not seem to realise that many of the concessions they make to the plans simply alienate GPs.
As Marlborough News Online has been reporting (see items in August 2011 and this month), GPs do not like the way the initial promise of power to commission has been eroded with more and more bodies and duties inserted into the system to look over their shoulders and monitor them.
On the other hand, as Dr Williams puts it, “patients’ expectations have been raised” by such promises as “No decision about me without me” which was at the heart of the White Paper and is being strengthened in government amendments to be debated this week in the House of Lords.
