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Wednesday 28 September 2016
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Lansley's sweeping reforms and the tide of uncertainty

ANNE CRANDLES

Practice Management Adviser,
Boroughloch Medical Practice

Just a few weeks ago, the announcement of the new health secretary was reported as being positively welcomed by GPs.

"Mr Lansley is the kind of man GPs could work with," enthused one Avon GP.

In June, Andrew Lansley began to unveil his plans for the health service, explaining that there would be "uncertainty" in the NHS as a result of "tough choices" he would make to improve quality of service and meet rising demand. He stated that:

  • Government, doctors, nurses and managers would work together on a shared vision, driving up standards, providing better value for money and creating a healthier nation.
  • The focus would be on quality and outcomes, with more devolved responsibilities.
  • Patients would be at the centre of decision-making.
  • Management costs would be reduced – ultimately by 46%, producing a £850m saving by 2013/14.

To this end, a revised Operating Framework for 2010/11 was hastily published. While the main health priorities all remain – patient access, infection control, improving the nation's health, reducing inequalities, enhancing the patient experience and being ready for states of emergency – the removal, amendments and general tinkering are of great concern to general practice.

The rationale for removing targets that "have no clinical justification" is understandable – but, as ever, the impact of policy will be felt in practices.

  • Taking away the 48-hour access target will have major consequences on the day-to-day running of practices – will managers continue with their current appointment systems, go back to open surgeries or (please no!) appointment schedules that are jam-packed for weeks on end. Or what?
  • Will the reductions of other targets (eg, the four-hour A&E waiting time target has been reduced from 98% to 95%) push patients back into our waiting rooms, adding pressure to our new appointment systems?
  • The 18-week referral to treatment target will no longer be policed from above, which has some merits but also opens the door to gaming.
  • GPs will be given substantially more financial powers and control: 80% of £100bn to be exact, with an expectation that GPs will group into 500 commissioning consortia. I wonder who in the practice will get to organise that?
  • In return for the power and money, GPs may also get the unpleasant tasks of making future rationing decisions and implementing cuts. More bad press for practices to deal with.

So, for "uncertainty" read "more work with fewer people to do it". The unions are incensed at the two-year pay freeze and likely cuts. The media are hinting that additional, as yet hidden, cuts are still to be announced. Worst of all, Mr Lansley has personally insulted Jamie Oliver!

And then, just as we are getting used to the idea of removing targets, a whole new raft of quality standards, with 30 measures in three clinical areas – dementia, stroke and blood clots, were announced. With a further 150 sets of standards to follow! But these standards will not be enforced by central government. Instead, doctors will be expected to work out how these might be achieved – presumably part of that devolved responsibility promise!

Seems to me that uncertainty can damage your health (service). Wonder what that GP in Avon thinks?