NHS in England is poised for reform

(Benjamin Franklin biography)

The cycle of NHS reform has come around again, just about on time. Past history shows that the whole thing is reorganised every three or four years . We don't know if it does any good, because it's never left alone for long enough to find out1. Is this time any different?

Size is everything

Smaller PCT's have trouble negotiating with the much larger hospital trusts. In 2004, hospital trusts were tasked with ensuring that the contracts they established with PCT's were 'sustainable'. Meanwhile, PCT's were tasked to have the contracts completed and signed by mid April each year. The results were predictable and inevitable. Apart from anything else, hospitals typically negotiated with two or more PCT's, and argued that their form of the contract was the only one that everyone would agree to. Over the last six years, as PCTs developed community services and grew larger, contracting is a more balanced affair2.

When we have 500 GP Commissioning Consortia, what can we expect?4

Disruption is always destructive

CivitasIn 2006, the number of PCT's in England was reduced from 300 to 152, through merging 222 PCT's (to 72) and leaving 80PCT's unchanged. Every year, the Healthcare Commission Annual Health Check rates, amongst other things, 'quality of services' and 'use of resources'. Civitas, a UK social policy Think Tank, has compared those PCT's formed from mergers (72) with those that were unchanged (80) using these indicators. The analysis found that the mergers led to: an absolute drop in performance on 'quality of service' and 'use of resources' lasting at least one year, compared with improved performance on both indicators for PCT's that were not merged; and a period of three years before the relative performance of the PCT's that were merged reached premerger (i.e. 2005/06) levels of those that were not3.

What's on the agenda?

Could this be a way of finding a fall guy in a longer-term aim of making healthcare services accountable to the local population? Could it be that the GPs are "set up to fail" so that local authorities can take over the management of the commissioning of health care?

Wouldn't it be simpler to take the bits of the PCT that appear to be working (and now, after four years, it really dial does appear that the PCT's ARE working), and simply make them report into the local authority?

Oh, but that would mean that the NHS and Local Authorities would have to pay for TUPE and redundancies, and the whole point of this ConDem(n) exercise is to get people off the public sector-funded pension.


1 "The not-so magic roundabout of NHS reform" Health Care Manager (Autumn 2010) issue seven, p10 - 11, James Gubb

2"PCTs make a good shot at privatisation" Health Service Journal (9 Sept 2010) p12-13 Dave West

3"NHS Briefing on moves to GP Commissioning" Civitas: Data Briefing 10 July 2010 James Gubb

4"GP Consortium Pioneer says PCTs are a vital safety net" Health Service Journal 7 Oct 2010 Steve Ford

We think we are on the right road improvement because we are making experiments – Benjamin Franklin (1706 to 1790)