New contracts for consultants and GPs are not to blame for NHS debts, says the British Medical Association (BMA) in its response to the Public Accounts Committee (PAC) report on financial management in the NHS published today (Tuesday 20 March 2007).
Dr Jonathan Fielden, chairman of the BMA's consultants committee, said: "The NHS is in a financial mess because of the millions spent on ill-thought-out and incoherent NHS reforms. You just need to look at the vast sums of money poured into chasing poorly commissioned NHS targets set to political timescales, accounting changes, private finance deals, overpriced contracts with the independent sector and the grossly overspent IT project to see where the NHS cash is disappearing.
"The Department of Health (DH) has already dismissed a link between new contracts for NHS staff and NHS debt and has stated that the main reasons for financial failure are that some trusts did not allow for the accounting change, whereby trusts were no longer allowed to use capital money for revenue expenditure, and others suffered from the pressure to meet targets.
"NHS trusts have been struggling with debt for many years. Rising drug costs and an ever-increasing number of patients means that trusts are continually battling to keep their expenditure under control. At the same time, the government has introduced a plethora of targets and new centrally-driven initiatives that trusts have to meet.
"It is totally untrue to claim that clinicians show a lack of interest in financial matters. Doctors could not have been more vocal about the looming financial crisis and have become exasperated by the lack of funds and the devastating effect this has had on the patient care. Clinicians are being deliberately disengaged by trust managers who instead prefer to employ costly management consultants to come up with solutions already suggested by NHS staff.
"In its conclusions, the PAC recommends a partnership between financial managers and clinicians – a solution that the BMA has repeatedly called for. Perhaps now the government will listen. If it continues to ignore the profession it will continue to fail the NHS."
The new GP contract has demonstrated clear benefits for patients and the reports of overspends have been significantly exaggerated. Dr Hamish Meldrum, chairman of the BMA's GP's committee, said: "The new GP contract allows resources to be directly linked to the quality of care. The Quality and Outcomes Framework (QOF) encourages and rewards GP practices for providing high-quality care, and by looking after patients that reflect the best medical evidence of what actually works.
"Practices have consistently achieved exceptionally high scores, demonstrating the excellent care provided to patients. The GP contract was overspent because the DH misjudged how hard GPs were working." Dr Meldrum said that because family doctors provided higher-quality care than the government had budgeted for, the extra cost was £150m.