NHS reform: GP choice or market madness?

Submitted by Matthew on 2 February, 2011 - 10:00

The BMA has been in the vanguard of opposing the Health and Social Care Bill now being debated in Parliament, but it is not a consistent or coherent opponent.

For instance, Dr Hamish Meldrum of the BMA qualified his criticism with this statement: “The BMA supports greater involvement of clinicians in planning services”.

Meldrum was expressing the BMA’s long-standing grievance that GPs are sidelined from decision-making processes in the NHS. But Meldrum should remember that these powers were stripped from medics as part of the privatisation process where clinically-trained managers were replaced with financially-driven executives.

Those executives introduced the internal market, which meant, for the first time in NHS history, financial restrictions were placed on clinical decision making.

The abolition of PCTs and “GP commissioning” under the new law will hand power back to the medics, but only to burden them with further financial restraint.

The Nuffield Trust’s research into medical groups in California shows the massive expansion of market mechanisms to regulate health care may come into direct conflict with GP’s duty of care.

Their report starts by acknowledging the strong financial incentives in the US to “over-treat” patients. For example, patients are given more expensive, complicated procedures in order that hospitals and doctors can tap higher insurance payouts.

To counteract this tendency, firms like Kaiser Permanente have incentivised “quality primary care” that promotes “prevention” and “minimises costly hospital-care”. GPs are given money to keep people out of hospital.

Meanwhile it is unclear that the patient has received the correct treatment.

And more bureaucracy will be created around the distorted structures of the new system.

The details of GP incentives in the UK are not finalised. But however it is organised, we can expect financial considerations to increasingly influence clinical decision-making and distort health needs.

These tendencies will be exacerbated by shortfalls in funding. The Guardian (31 January) reported that west London GPs involved in a government “pathfinder” scheme for the new system will face a £1 billion shortfall in funding by 2014-15. And an internal NHS document says “closing this funding gap will require significant change in how we deliver healthcare”. Saving money will be “the bottom line” in the new system.

The old NHS operated without cash exchange, without financial incentives for staff or services. Services and workers in the NHS were motivated by values of human decency not individual monetary gain. Clinical decision making was made without pressures of the market clouding medical judgement. To combat the Health and Social Care Bill, opposition groups will need to articulate an alternative political vision which tells the truth about privatisation and also challenges the underlying contemptuous view of humanity as being motivated purely by greed. Because that is the ideology of the boss-class.

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