Health reform: a prescription for disaster?
|May 20, 2011||Posted by Amy Proudfoot under national|
After jumping through countless hoops and working hard for years (but that’s a rant for another time), I have finally achieved my goal; an offer to study medicine at university. But now the future of the NHS is uncertain and with the possibility of cuts to the number of healthcare staff, will there be a job for me when I graduate? And if so, what will that job entail?
The Health and Social Care Bill, spearheaded by the Conservative Health Secretary Andrew Lansley, has come under fire from both the Royal College of Nursing (with 99% of its members supporting a vote of no confidence in the bill) and the British Medical Association. It is also fast becoming a divide in the coalition government, with Nick Clegg recently announcing that his party would not vote in favour of the reforms unless major changes were made, although whether this is just a sulky response to the Lib Dem’s thrashing in the local council elections is unclear. The main point of the bill, and also the main point of contention, is the scrapping of the Primary Care Trusts that currently manage most non-emergency care, and transferring this power to GP consortiums, hence effectively giving GPs two jobs; the treatment of patients they currently deal with but also the financial management of primary care.
GPs account for roughly 25% of all qualified doctors in the UK and from the start of a degree it will take a minimum of ten years of training to become one. Ten years of intensive training in medicine and its applications, not in business management. Similarly, the A-levels most prospective medical students take will be biology, chemistry and a random other, not business and economics. So, why are GPs being expected to do a job they haven’t been trained for – and if they were to be trained for it, would you want to be treated by a doctor that had a split speciality? It also couldn’t be squeezed into the same amount of time for training, since due to the European Working Time Directive trainee doctors cannot do more than 48 hours a week, which is already pushed to the limit during the five years after degree level. In addition, people already complain about long waits for appointments to see their GP, a problem that would only get worse if doctors were forced to allocate time to manage their accounts, although in reality many of the people sacked from the PCTs would be taken on as private advisors by the new consortiums, most probably getting paid more than they would have previously earned.
In addition to this, there is a worrying plan to encourage the NHS to compete with the private sector for business and although the theory behind it is that it will drive NHS services to become as good as their private counterparts, restraints on budget may result in corner cutting so as to offer treatments as cheap as possible, so that GPs choose them for cost effectiveness rather than being what’s best for patients. These plans are an extension on the current Practice Based Commission (PBS) system, where GPs (and to a limited extent, patients) can choose where to purchase a certain procedure from, but the price has been fixed by the NHS with the reasoning being that since the price is the set, hospitals have to compete on the standard of their treatments in order to attract the custom from GPs. The trouble with both this and the new proposed system is that since the GP practices have to pay for it, they may choose a cheaper option that is not as beneficial to the patient in order to save money. Increased privatisation may also lead to vested interests, where GPs recommend patients to ‘friends’, in view to getting rewarded in kind later on.
What do I suggest instead? While I don’t pretend to have an in-depth knowledge of economics (which is why I am aiming to be a doctor, not an accountant or a banker), I do agree with cutting down on some of the pointless bureaucracy rife in the NHS. However, cutting out the management level entirely is only going to be detrimental, for the reasons stated above. Although in my perfect world the NHS would have unlimited funds, I know that is entirely unrealistic and perhaps instead GPs should be prepared to take a pay cut, although this obviously wouldn’t be a popular move. However, there are double the amount of applicants to medicine as there are places and many of those who are unsuccessful would make great doctors; doctors motivated by the desire to succeed and help others rather than their next pay packet. With regards to increasing competition, PBS is already too much of a privatisation for my liking as I feel that quality should be the emphasis, not cost. Besides, a surgery that has been botched due to poor funding is only going to cost the NHS more money overall, since they will have to pay for both a correction and for compensation to the patient.
Luckily, amid the increasing pressure, David Cameron and Andrew Lansley seem to be promising to revise the proposed plans, so I can only hope that the changes will be substantial and result in a well thought through plan that will be more beneficial both for doctors and their patients.
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