Governments like change, so when the UK acquired its recent coalition government, it didn’t take a genius to predict that change was on the way for the National Health Service. The NHS holds a rather special place in the hearts of the UK electorate. Although the UK media loves to hate it, and most people gripe about it, the bulk of the population have a great affection for what it does. Few realise that outside the UK most people involved in the medical industry view it with admiration. Because of its popularity, the incoming government mollified public concern by announcing that they would “ring-fence” spending on the NHS, but then promptly started to change it.
That change was heralded by a consultation on “Liberating the NHS”, which was slipped out before the summer holidays, probably in the hope that few would notice or respond to it before the deadline at the end of September. It signalled a major change in direction, where control would be moved from the current Primary Care Trusts (PCTs) to consortia of General Practitioners (GPs).
That raises some concerns. The first is that we don’t train GPs to be managers. We still train them in much the same way we did a hundred years ago. So the most likely effect is that all of the managers who get made redundant from PCTs will simply go and work for GP consortia. And as there are far more of these, it just results in an even bigger set of people micromanaging.
The more worrying concern is what effect this will have on prescribing practice. The consultation document keeps on trotting out the phrase “clinical evidence”, implying that the NHS and local GP practices base everything they do on good clinical evidence. It’s a nice theory, and it would be nice to think that those developing this policy change believed in and supported it. It should be possible – we have a body called NICE (The National Institute for Clinical Excellence) whose job is to promote it. But as soon as everyone got back from their summer holidays, Andrew Lansley – the new Minister for Health, got out his rusty shears and castrated NICE. It’s difficult to understand why, but the implications for the NHS and GPs are disastrous. It’s goodbye to clinical evidence, and hello to whoever can get the most publicity for their favoured drug of the month.