Post by Anthony Matthews,
NHS campaigner based in Penzance
After much fierce controversy the Health and Social Care Act was passed by the coalition government in 2013 and implemented on 1 April 2013. The government’s cause for such a radical change rested on the premise that the NHS was no longer affordable, and that it needed to be ‘modernised.’
Although for many the Health and Social Care Act remained largely impenetrable, the main thrust was that primary care trusts and strategic health authorities were to be disbanded and in their place clinical commissioning groups – also known as GP consortia – were to take control of about £60bn of the NHS budget and commission local services. Commissioning was to be based on a competitive tendering model which meant that NHS contracts were to be opened up to the private and voluntary sectors – with the government maintaining that involvement of private providers would improve the NHS through competition and price.
Within the new system GPs were to be central to the running of a radically reformed NHS – although what this meant in reality was that health corporates were already gearing up to take on the complex business of commissioning.
One result of these changes is that one tenth of GP surgeries are now privately owned. The 150 primary care trusts have transformed into 211 CCGs and much of the CCGs work is outsourced to ‘commissioning support units (CSUs). The people who work within these groups are not considered to be NHS employees and are not subject to the Freedom of Information Act. By 2016 these services will have been put out to competitive contract.
CCGs and CSUs are monitored by NHS England, an organisation that employs 4,000 people and has 27 local area teams that don’t meet publicly or publish papers. Among the other tiers are the health and wellbeing boards, Healthwatch England, local Healthwatch patient groups (which are prohibited from conducting any campaigning deemed to be political), citizens panels, clinical senates etc. The Royal College of GPs has described the resulting level of accountability as resembling ‘spaghetti junction’.
Another result of the reforms is that a GP could be constrained from sending a patient to any part of the NHS anywhere in the country for treatment due to a contract with a provider. Many GPs are now issued with targets to lower referrals to hospital. These referrals may have to be passed through a management centre where one in eight are rejected.
The concept of GP control has been eroded to the point where, rather than being in charge, GPs are effectively reduced to rubber stamping decisions made by NHS England and commissioning support services. Only one third of GPs are actively concerned with the work of CCGs and of those more than a third have links with, or shares in, private medical companies and insurers – leading to the phenomenon of the ‘doctorpreneur’.
An important concern is the consequent collapse in morale, with 6 out of 10 GPs now considering early retirement. In the words of Dr Maureen Baker (chair of the RCGP) general practice is now ‘on the verge of extinction.’