Monday, April 21, 2008

NHS - Number 1 Battle Ground in the Next General election

As I wrote before, to Gordon Brown the NHS is 'Not His Specialty'. Hence, the NHS, is likely to be the number one battle ground in the next election. Today, David Cameron offered much needed direction to a health organisation that spends around two billion pounds per week! He has said:
"In a nutshell, GPs should control the budgets that NHS patients are entitled to. There is a good economic rationale for this. Budget-holding is a natural guarantee of efficiency, ensuring that money follows the patient and it is spent on frontline care rather than on bureaucracy. GPs - rather than remote managers - should be responsible for reconciling the available resources with clinical priorities and patient choice. And there is a good health rationale for GP budget-holding too: what's called the continuity of care. The family doctor service is the way to ensure that - even though the patients may see many specialists - there is always one doctor in charge: the doctor closest to the patient. This is especially important when it comes to preventative action or the management of chronic conditions, which require significant patient involvement.Five years ago Gordon Brown said that "in healthcare the consumer is not sovereign" - meaning that patients should not be trusted or expected to manage their own care. Well I disagree. Because I believe in general practice. With the GP to advise the patient and to commission care on their behalf from a variety of providers, then in healthcare the consumer can be sovereign."
I totally agree that GPs are paramount to patient care. As a psychiatrist, I daily rely on GPs knowing their patients. They provide vital information about both long term health and subtle changes in patient presentation. I'd like to thank all the GPs I've trusted to manage my patients after hospital discharge. If I trust them with life and death, I would certainly trust GPs to spent money wisely.
I believe GPs, like hospital doctors, want the funds to follow the patient. The time has come to stop following the dictum of management consultants or government quangocrats. The political tide must turn. The patient must be the put at the heart of the NHS.


Anonymous said...
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Anonymous said...

Couldn't agree more Michelle. As a working GP and tax payer, I would add one further thing. Introduce competition within the provision of Primary Care. In my experience, patients know which doctor they want to go. Patients should have choice of hospital and also choice of GP.

The Shrink said...

Evidence is budget holding effects change in decision making when it's your own money. Spending other peoples' money or virtual budgets just isn't real. Thus, GPs budget holding really seems a nice but empty notion that's not going to impact on my care when I'm a patient.

I do think managed choice is a real tool to effect change. If one unit's great and another's rubbish, the rubish one will have poor activity and will not be sustainable, so will change for the better or close.

Will patients be happy that local units close, because (as it will be seen) GPs won't support their local hospital? GP's get a lot of bad press at the moment. Being seen as the financial managers of the NHS, thus the ones responsible for closures and shortcomings, is adding more undeserved woe at the GPs door, no?

Jobbing Doctor said...


Thank you for your post. This is one of the first positive things I have read for ages. I do agree that we are (a) Pretty Good and (b) Know the patients.

I don't really want to manage budgets, but I do want to see an improvement in the service, closer to the patient. I'm not a good financial manager (ask Mrs Jobbing Doctor) but if we could actually cut through the morass of central controls, then things will get better.

Dr Michelle Tempest said...

Thanks Arthur, 'the shrink' and 'the jobbing doctor'. I agree that not all GPs will want to be budget holders. But I'm sure not all would have to be, in a less centrally organised rigid system.

I personally would trust GPs, people who understanding healthcare and patients more than pen pushers. However, I would also like to control my own department budget and spend it on evidence based medicine rather than targets.... but perhaps because I am a psychiatrist... I like to be positive and believe we'll get there (eventually!)
Thanks for the comments

Marc Blank-Settle said...


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