Practice managers should be braced for fundamental changes to the NHS as a result of its funding shorthall, which could require "ruthless efficiencies" and limits to NHS supplies in order to survive, according to NHS Alliance Practice Management Lead Wendy Evans.
Speaking at yesterday's (9 June 2009) Management in Practice Event in Manchester, Mrs Evans (pictured), a practice manager since 1979, told delegates that the reported 2.5% NHS funding cut from 2010 may even mean the NHS would have to consider adopting a copayment policy in order to continue.
"We can't afford the NHS as it is," she said. "We're going to have to pay for it somehow."
A report from the NHS Confederation today (10 June 2009) warned that the health service will have a £15bn funding shortfall over the next decade, and that after 2011/12 the health service would be in a "very different and extremely challenging" situation.
The keynote speaker at Management in Practice Manchester, Mrs Evans said practices may have to introduce charging patients a premium for evening/weekend consultations and/or bring in surcharges for other services.
She suggested that the introduction of "top-up" payments for expensive cancer drugs, whereby patients pay for private treatment themselves while continuing to receive NHS care, could set a precedent for how healthcare services are provided in the future.
In an address that considered the future of the NHS in light of its past, and the impact on the practice manager's role, Mrs Evans also predicted that the future for GP surgeries meant "regulation, regulation, regulation", as practices seek reaccreditation and as the Care Quality Commission oversees the delivery of GP services.
There was also much speculation over the development and future of the Quality and Outcomes Framework (QOF) at the Manchester event.
In a presentation on practice finance, specialist medical accountant Rosemary Smith indicated that upcoming changes to the QOF may mean points are more difficult to obtain, placing greater pressure on managers to maximise cost-effectiveness and profits elsewhere.
Dr Stephen Campbell, a senior research fellow for the National Primary Care Research and Development Centre, which is partly responsible for a review of the QOF and the piloting of new indicators for 2011-12 onwards, spoke to a packed conference hall on efforts to ensure that the QOF is updated to maximise quality improvement, and researchers' ongoing need to monitor achievement in areas where indicators are removed.
In her opening address, Mrs Evans had even suggested that independent regulation may lead to the removal of the QOF. At a Question Time-style panel session, Dr Nick Goodwin, a senior fellow at healthcare think tank the King's Fund, was in agreement that, with a possible change of government on the horizon, changes to primary care could not readily be predicted.
"Will the GP contract still be around in a few year's time?" He asked. "All bets are off as to how services will be provided in the future."
In the same panel session, Mrs Evans voiced her hopes that the NHS funding gap would not mean that money would be taken from primary care to assist secondary care, threatening its quality. "General practice in the UK is the best in the world," she said. "No one would think otherwise."
Related article: Health service facing £15bn financial challenge
Does the NHS funding shortfall mean that primary care will need to change drastically? Your comments (terms and conditions apply):
"NHS can save money by reducing unnecessary expenditure, with strong monitoring need to find those areas. General practice should not be the easy target" – Nazma Ansari, location withheld