The coalition NHS shakeup

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  • mal 18 Jan 2011 11:55:22 22,683 posts
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    Disclaimer: I'd have expected dm to make this thread already, but search fails me. Apologies if old.

    So, the government have announced their plans to save cash on the NHS by getting rid of the Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs). The PCTs are responsible for ordering end user services from hospitals and other parts of the NHS, so that when a GP refers you to get an x-ray, the hospitals services are there and properly funded.

    The plan now is for GPs to band together and order services from the hospitals and health centres directly, but they can also get services from private clinics. As I understand it, they'll be encouraged to do this, if the clinics can offer services at a lower cost, in order to make their budgets go further.

    Now, the PCTs have come in for quite a lot of criticism over the years (though not so much since NICE was founded and ended the 'postcode lottery'). And getting rid of two levels of agency will reduce bureaucracy, which gown knows the NHS needs.

    But to me this sounds like the worst idea ever. Plenty of private clinics will be able to undercut the hospital, primarily because they don't have to fund expensive items like Accident and Emergency. The NHS works on a priniple of economies of scale and or sharing the cost of expensive drugs and services. If the GPs do take this up, funding on A&E will drop, and well end up with an even worse case of a postcode lottery where it depends not only which local authority you come under, but which GP you go to whether you get drug X or not.

    I don't know how this affects A&E - I don't expect GPs to be funding A&E directly when it's got nothing to do with them. The BBC has got a short Q&A up here, but it doesn't go into any specifics of how the plan will work.

    Cubby didn't know how to turn off sigs!

  • X201 18 Jan 2011 11:59:23 15,576 posts
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    /Gets Hot Dog and Hot Potato stall out of garage and opens for business. - This could be a long one.
  • Margaret_Thatcher 18 Jan 2011 12:00:34 57 posts
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    You all just need to grow up.
  • kalel 18 Jan 2011 12:05:03 88,336 posts
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    FluffyTucker wrote:
    I'm Bupa, so the less of my tax spent on the NHS the better

    You do know that Bupa only cover acute conditions generally?
  • mcmonkeyplc 18 Jan 2011 12:10:37 39,467 posts
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    Mal:

    mal wrote:
    But to me this sounds like the worst idea ever. Plenty of private clinics will be able to undercut the hospital, primarily because they don't have to fund expensive items like Accident and Emergency. The NHS works on a priniple of economies of scale and or sharing the cost of expensive drugs and services. If the GPs do take this up, funding on A&E will drop, and well end up with an even worse case of a postcode lottery where it depends not only which local authority you come under, but which GP you go to whether you get drug X or not.

    I don't know how this affects A&E - I don't expect GPs to be funding A&E directly when it's got nothing to do with them. The BBC has got a short Q&A up here, but it doesn't go into any specifics of how the plan will work.

    How can you think it's bad for A&E and then not know how it affects A&E?

    Come and get it cumslingers!

  • Stickman 18 Jan 2011 12:12:01 29,666 posts
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    The main feeling I get is that it's a neat way of shifting responsibility from the government to the GPs.

    Ironically, seeing as this is being touted as giving even more options to the patient, the more Foundation hospitals that we get (and eventually they ALL will be), the poorer patient choice gets imo. Why would a hospital that essentially governs itself choose to do a procedure that runs at a loss? Minor or intermediate procedures will be fine, but I can see major surgery having fewer and fewer places that do it.

    First step in totally privatising healthcare in the UK I feel.

    THIS SPACE FOR RENT

  • stephenb 18 Jan 2011 12:12:13 2,749 posts
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    If GP's find private clinics that are cheaper than the local NHS equivelant and continue to use them. Then that surely gives the Government the chance to close down or scale back said NHS facility in that area?

    I spy stealth raping and pillaging of the NHS infrastructure.

    PSN : v--WEDGE--v

  • speedofthepuma 18 Jan 2011 12:14:28 13,302 posts
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    Poisoned chalice.

    One of a myriad of reasons why I fucked off.

    I lurk. If I've spoken to you, I'm either impassioned, or drunk.

  • speedofthepuma 18 Jan 2011 12:17:41 13,302 posts
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    Smuggo what do you do?

    I lurk. If I've spoken to you, I'm either impassioned, or drunk.

  • mal 18 Jan 2011 12:18:03 22,683 posts
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    mcmonkeyplc wrote:
    How can you think it's bad for A&E and then not know how it affects A&E?
    Well, if the money that currently gets spent on A&E comes out of money originally intended to treat someone's angina which ended up only needed a cheap course of aspirin, but instead the angina money goes to a private clinic, the hospitals will only get the budgeted amount for A&E which they say*
    is in practice not enough to run an A&E department.

    * It's what I read into what the bloke on the Today programme this morning said anyway.

    Cubby didn't know how to turn off sigs!

  • Mr_Sleep 18 Jan 2011 12:19:34 17,171 posts
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    Stickman wrote:
    First step in totally privatising healthcare in the UK I feel.

    This will be a very sad day indeed.

    Somehow it feels highly appropriate that there's a sock called Margaret Thatcher posting on this thread.

    You are a factory of sadness.

  • mcmonkeyplc 18 Jan 2011 12:19:51 39,467 posts
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    stephenb wrote:
    If GP's find private clinics that are cheaper than the local NHS equivelant and continue to use them. Then that surely gives the Government the chance to close down or scale back said NHS facility in that area?

    I spy stealth raping and pillaging of the NHS infrastructure.

    Surely not? Not a government with the Torries at the helm. That unpossible! :p

    On the other hand I can see what they are trying to do. They're trying to create an internal market to drive down costs and improve effciencies. HOWEVER they need to make sure they have adequate regulations in place that prevent hospitals dropping services that make no money for them, cause they are still required. Hopefully some Lib dem twat will get it through to the tory scum that market failure does exist.

    Come and get it cumslingers!

  • Stickman 18 Jan 2011 12:21:37 29,666 posts
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    StarMagic wrote:
    Fine, as long as all gps do a year of business studies.

    I'm yet to speak to a GP who thinks this change is a good idea. Most of the comments are "I'm a doctor not an accountant."

    THIS SPACE FOR RENT

  • mcmonkeyplc 18 Jan 2011 12:22:24 39,467 posts
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    mal wrote:
    mcmonkeyplc wrote:
    How can you think it's bad for A&E and then not know how it affects A&E?
    Well, if the money that currently gets spent on A&E comes out of money originally intended to treat someone's angina which ended up only needed a cheap course of aspirin, but instead the angina money goes to a private clinic, the hospitals will only get the budgeted amount for A&E which they say*
    is in practice not enough to run an A&E department.

    * It's what I read into what the bloke on the Today programme this morning said anyway.

    Put that in your OP then, cause without it, it's slightly confusing how you're coming to your opinion.

    Come and get it cumslingers!

  • mal 18 Jan 2011 12:23:09 22,683 posts
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    Stickman wrote:
    I'm yet to speak to a GP who thinks this change is a good idea. Most of the comments are "Damnit Jim, I'm a doctor not an accountant."

    Fixed for trekkies.

    Cubby didn't know how to turn off sigs!

  • nickthegun 18 Jan 2011 12:24:38 60,415 posts
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    They will just palm all the paperwork off onto the golden girls on reception.

    ---------------------------------------------------------
    My man gives real loving that's why I call him Killer
    He's not a wham-bam-thank-you-ma'am, he's a thriller

  • speedofthepuma 18 Jan 2011 12:25:42 13,302 posts
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    Mind you, I will point out that most GPs are small business owners, so thereforearen't completely clueless regarding business issues. Nothing on the scale suggested here mind you.

    What will happen is the PCT staff will mostly be re-employed and work for the GPs.

    I lurk. If I've spoken to you, I'm either impassioned, or drunk.

  • Tom_Servo 18 Jan 2011 12:25:49 18,004 posts
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    /glass of water begins to shake

    /hears thumping outside

    Oh God... DARKMORGADO'S COMING
  • disusedgenius 18 Jan 2011 12:27:06 5,394 posts
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    Smuggo wrote:
    I really don't think it's a good idea to make them have to try understand anything other than medicine.
    Yeah, this.

    Giving administration stuff to Head Nurses I'm all for but this just doesn't seem like a great idea to me. I also find the idea of competition in this sector pretty distasteful (which they've mentioned along with these plans).
  • Chimpus 18 Jan 2011 12:32:00 751 posts
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    You will find enthusiasm for the change with GPs who are already involved in Practice Based Commissioning work and are already involved with commissioning with the Primary Care Trusts.

    Worryingly that is a small percentage of GPs.

    All in all it probably means I lose my job in three months but I didnt like it any way so ner.
  • mcmonkeyplc 18 Jan 2011 12:53:05 39,467 posts
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    That's what you think Chumpus. You're role will be transferred to the closest clinic and you will keep your job but have to work for the new boss and you will continue to hate it.

    Come and get it cumslingers!

  • chopsen 18 Jan 2011 13:16:31 16,125 posts
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    It'll be a fucking disaster.

    In principle, it's not a bad thing to decentralise the decisions on how to allocate resources for healthcare, as the needs to vary from place to place. This was the problem that Labour had - they kind of thought along the same lines of delegating commissioning to a more local level with Practice Based Commissioning, but lacked the balls to completely devolve power to a local level meaning the process gummed up and nothing happened. Having some kind of input from GPs is probably not a terrible idea either, as they are the ones that have to explain to patients who come through the door why it is there is hernia repair service at the moment or sorry, you'll just have to put up with you're varicose veins, they're not being funded.

    BUT

    They are going about this all wrong. Politicians, especially with healthcare, seemed to be obsessed with big grand gestures. Nobody trials ideas out in one geographical area 1st, nobody conducts real work feasibility studies. They just go "this will be awesome" and go ahead and do it on a national scale. They then say "ooh, that didn't work" and then do another massive overhall, at every step throwing the baby out with the bath water. Instead of seeking to identify what is good about what is in place at the moment, it's scorched earth time, every time. And it has to fit in with the timetable for the next general election.

    As speedofthepuma said above, probably just what will happen is consortia of GPs will band together and effectively re-employ everybody who worked at the PCTs to form administrative bodies to do the commissioning on their behalf. A single GP practice or small consortia is going to be too small to have enough weight to negotiate with the larger trusts, and this will just cause needless duplication of work as a lot of core stuff is the same.

    As always, same shit, different govt. Fundholding, PBC, consortia. Health authorities, small PCTs, big PCTs, GP commissioning consortia. The names change but the job's the same. The only difference this time is that the govt seems hell bent on doing it on a very tight schedule and more open about getting private providers in.

    Private providers have always been there. Every GP practice ever is a profit making business with a contract with the NHS. Labour developed models such as the APMS contracts and independent treatment centres which were ways in for more private companies to provide health care. Nothing is new.

    Oh, and on the "post code lottery" thing. That really gets on my tits, that phrase. It's not a lottery: a lottery is random. Where there are local variations in service, it's usually for a reason. Somebody, somewhere, thought that something else deserved the money instead in that part of the world. It's one of the most retarded phrases used in discussions in health care resource management, and it only ever gets used by politicians and journalists who haven't got a clue what they're talking about.
  • Deleted user 18 January 2011 14:29:02
    Tom_Servo wrote:
    /glass of water begins to shake

    /hears thumping outside

    Oh God... DARKMORGADO'S COMING
    he's outside your house? poor you. :(
  • spamdangled 18 Jan 2011 14:50:31 27,410 posts
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    Stupid idea. Most GPs wont have experience managing a budget, so there will be monumental fuckups in funding of patient care. Not only that, but I expect a lot of practices will employ private consultants to manage their budget for them.
    Opening healthcare up even more to private companies is just the first step on the road to total privatisation - something the Tories have wanted for a very long time.

    3DS: 4055-2781-2855 Xbox: spamdangled PSN: dark_morgan Wii U: Spamdangle Steam: spamdangled

  • mal 18 Jan 2011 15:14:31 22,683 posts
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    darkmorgado wrote:
    Opening healthcare up even more to private companies is just the first step on the road to total privatisation - something the Tories have wanted for a very long time.

    Cameron says 'grow up' ;)

    Cubby didn't know how to turn off sigs!

  • ElNuevo9 18 Jan 2011 15:18:08 13,479 posts
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    My dad is a consultant anaesthetist, deputy medical director and Director of infection and prevention control, so I don't give a flying fuck, me and my immediate family will always get fantastic healthcare.

    /selfish

    Hated, adored, never ignored.

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