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BMJ cover

Why does this week’s cover of the BMJ show money hungry vultures flying over NHS staff?

April 1st [April fools day] marked the day of the takeover of the NHS by the National Commissioning Board. The new changes are designed to open up the NHS in England to competition by for profit companies. [see my book Medical School Interviews Everything You Need To Know The Knowledge p60-65]

 PCT [Primary Care Trusts] have been abolished and their work allocated to GP led commissioning groups who will now have responsibility to ensure their patients’ health needs are met. They will decide how 80% of the NHS budget is spent. GPs have been given this responsibility as they have daily contact with patients and local services and know their patient’s needs. GPs will have to put services out to  tender [consider any willing provider’] and any organisation can bid to provide services not just NHS hospitals. Critics warn that big, often multi national companies who have been active in lobbying the government will ‘cherry pick’ the most profitable services and destabilise the rest of the NHS. For example the NHS has used private providers to provide surgery to reduce waiting lists. NHS hospitals and private hospitals get paid per case [payment by results] and private companies have had exclusion criteria where they do not treat the elderly, those with other serious illnesses and mental health problems – they ‘cherry pick’ those that are likely to recover sooner; the easier more profitable cases leaving the more complicated for the NHS. There is a risk of destabilising local NHS services. For example if a lot of orthopaedic surgery is provided in private hospitals, the local NHS hospital may employ fewer orthopaedic surgeons and nurses and the hospital might not be able to cope with a major accident involving many injuries.

     The campaign group ‘Keep Our NHS Public’ spokeswoman Dr Jacky Davis, says private firms have a big advantages in bidding for business. “The private sector – their expertise is in winning government contracts. That’s what they do. And they have backrooms full of lawyers. They have very deep pockets to spend on tendering for NHS services.” I myself have noticed many articles in the press praising private organisations such as Circle and the privately run NHS hospital Hinchingbrooke. Private companies are good at marketing and lobbying the press and others; contrary to the impression given by journalists Hichingbrooke Hospital and Circle have serious problems.

Those in favour of the changes think that increased competition will lead to improved and cheaper services. 

What exactly will GP commissioning involve? Not sure?  Well you are in good company. The chief executive of NHS London, Ruth Carnall, admits to confusion. “I’m supposed to know what’s going on re all of this. I don’t.” she tweeted last week. The House of Lords committee responsible for scrutinising the regulations concluded last week that there is no common understanding” of the new rules, saying that the Department of Health has given “insufficient time” to set the system up properly and enable thorough scrutiny. Clare Gerada, the President of the Royal College of General Practitioners who are supposed to implement the reforms described them as a set of regulations that no one understands and that seem to conflict with the previously stated intentions of the government that wrote them.”

There is one thing is certain. GPs do not relish becoming the masters of the new NHS universe. Clare Gerada, their representative, said last week that the new changes allow for;

the wholesale dismantling of the NHS and privatisation of the supply, organisation, planning, finance, and distribution of healthcare. She goes on to say that the regulations will leave general practitioners

“bearing the brunt of the public’s wrath, while much of the health budget is handed over to the for-profit commercial sector, services are closed, and entitlements to universal healthcare are eroded.”

Is this the beginning of the end of the NHS?