Andrew Haldenby and Professor Nick Bosanquet are co-founders of Aiming for Health Success, a new research and advisory firm.
Sajid Javid has a choice to make: between a more productive NHS. or a campaign against GPs. We would urge him to give peace a chance.
The Health Secretary took a new line on NHS productivity in the wake of the Prime Minister’s leadership vote. Speaking to the Times, he said:
“The NHS now has locked in the resources it needs. It doesn’t need any more money. What it needs to deliver for more people is not money: It needs reform.”
Hitherto, the Government had highlighted its generous spending increases, funded in part by the Health and Care Levy.
Meanwhile the campaign against GPs has continued. The Telegraph and the Mail have run weekly stories criticising the profession, typically over difficulties of getting appointments and in particular face-to-face ones (recent examples here and here).
The narrative is becoming fixed: that GPs’ unwillingness to see patients epitomises the bureaucratic, unresponsive NHS.
Javid has not been at the front of the campaign, but he has not been far behind. Last October, he made the NHS conduct a review each of the 6,500 GP practices in England, measuring their face-to-face appointments, overall appointment numbers, 111 calls and A&E attendances. That was the most interventionist act of any Health Secretary since the early years of the Blair Government.
Since then he has kept up the pressure, expressing his dissatisfaction with the level of face-to-face appointments at the last Health Questions for example. In a speech to a major NHS audience last week, he said, “I don’t think our current model of primary care is working” and “we need a plan for change”.
Perhaps as a guide to his thinking, he wrote a foreword to a think tank pamphlet arguing that GPs could be subsumed into hospitals, bringing an end to primary care as we know it.
Javid’s own landmark review into NHS leadership, by General Sir Gordon Messenger, explains why he should think again.
The review came to two conclusions. First, that top-down central direction of the NHS “creates an institutional instinct … to look upwards to furnish the needs of the hierarchy rather than downwards to the needs of the service-user”. The rule-setting over face-to-face appointments is an example of this.
The result, according to the review, is “poor behavioural cultures and incidences of discrimination, bullying, blame cultures and responsibility avoidance”. General Messenger concluded:
“These symptoms … should not be tolerated as they directly affect care of the service-user as well as the staff, and that they can be tackled but only through determined cultural change from the top of the system to the front-line.”
Jeremy Hunt was right to challenge Javid on the Government’s use of central targets in the House of Commons debate on the Messenger Review two weeks ago. It was striking that the Health Secretary refused the invitation to criticise targets.
The second conclusion was that: “the vast majority of health and care delivery never touches the acute sector, and it is in the interests of all to keep it that way”.
This is the point on productivity. Acute care, based in hospitals, is the most expensive way to deliver healthcare.
For many years, successive governments have sought to provide more cost-effective services out of hospital, in particular by supporting people with long-term conditions so that they do not suffer repeat hospitalisations. The whole purpose of Integrated Care Systems, established by the recent Health Act, is to support this new model of care. The campaign against GPs cuts directly across this.
The Health Secretary might reply that the difficulty of seeing a GP is so great a problem that he has to do something. In fact the situation is improving and will continue to do so.
The Government has been somewhat obsessed with recruiting more GPs, which has been difficult. But, crucially, there has been more success in recruiting other members of staff into primary care: numbers have risen from around 30,000 three years ago to over 40,000 now.
These expanded teams are a large part of the answer to improving access – more patients can see a nurse, physiotherapist, or other member of staff than under current arrangements. New technology is the other key factor, as a forthcoming Aiming for Health Success paper will show.
Javid is a Thatcherite. Margaret Thatcher’s main policy decision on the NHS was to improve productivity by improving management and introducing an internal market for hospital care. Her ideas culminated in GP fundholding, whereby GPs could choose to hold real budgets and buy non-urgent hospital and community services.
GP fundholding was abolished in 1998 by the incoming Labour government. How ironic if a Thatcherite Health Secretary was to follow in Frank Dobson’s footsteps.
Andrew Haldenby and Professor Nick Bosanquet are co-founders of Aiming for Health Success, a new research and advisory firm.
Sajid Javid has a choice to make: between a more productive NHS. or a campaign against GPs. We would urge him to give peace a chance.
The Health Secretary took a new line on NHS productivity in the wake of the Prime Minister’s leadership vote. Speaking to the Times, he said:
“The NHS now has locked in the resources it needs. It doesn’t need any more money. What it needs to deliver for more people is not money: It needs reform.”
Hitherto, the Government had highlighted its generous spending increases, funded in part by the Health and Care Levy.
Meanwhile the campaign against GPs has continued. The Telegraph and the Mail have run weekly stories criticising the profession, typically over difficulties of getting appointments and in particular face-to-face ones (recent examples here and here).
The narrative is becoming fixed: that GPs’ unwillingness to see patients epitomises the bureaucratic, unresponsive NHS.
Javid has not been at the front of the campaign, but he has not been far behind. Last October, he made the NHS conduct a review each of the 6,500 GP practices in England, measuring their face-to-face appointments, overall appointment numbers, 111 calls and A&E attendances. That was the most interventionist act of any Health Secretary since the early years of the Blair Government.
Since then he has kept up the pressure, expressing his dissatisfaction with the level of face-to-face appointments at the last Health Questions for example. In a speech to a major NHS audience last week, he said, “I don’t think our current model of primary care is working” and “we need a plan for change”.
Perhaps as a guide to his thinking, he wrote a foreword to a think tank pamphlet arguing that GPs could be subsumed into hospitals, bringing an end to primary care as we know it.
Javid’s own landmark review into NHS leadership, by General Sir Gordon Messenger, explains why he should think again.
The review came to two conclusions. First, that top-down central direction of the NHS “creates an institutional instinct … to look upwards to furnish the needs of the hierarchy rather than downwards to the needs of the service-user”. The rule-setting over face-to-face appointments is an example of this.
The result, according to the review, is “poor behavioural cultures and incidences of discrimination, bullying, blame cultures and responsibility avoidance”. General Messenger concluded:
“These symptoms … should not be tolerated as they directly affect care of the service-user as well as the staff, and that they can be tackled but only through determined cultural change from the top of the system to the front-line.”
Jeremy Hunt was right to challenge Javid on the Government’s use of central targets in the House of Commons debate on the Messenger Review two weeks ago. It was striking that the Health Secretary refused the invitation to criticise targets.
The second conclusion was that: “the vast majority of health and care delivery never touches the acute sector, and it is in the interests of all to keep it that way”.
This is the point on productivity. Acute care, based in hospitals, is the most expensive way to deliver healthcare.
For many years, successive governments have sought to provide more cost-effective services out of hospital, in particular by supporting people with long-term conditions so that they do not suffer repeat hospitalisations. The whole purpose of Integrated Care Systems, established by the recent Health Act, is to support this new model of care. The campaign against GPs cuts directly across this.
The Health Secretary might reply that the difficulty of seeing a GP is so great a problem that he has to do something. In fact the situation is improving and will continue to do so.
The Government has been somewhat obsessed with recruiting more GPs, which has been difficult. But, crucially, there has been more success in recruiting other members of staff into primary care: numbers have risen from around 30,000 three years ago to over 40,000 now.
These expanded teams are a large part of the answer to improving access – more patients can see a nurse, physiotherapist, or other member of staff than under current arrangements. New technology is the other key factor, as a forthcoming Aiming for Health Success paper will show.
Javid is a Thatcherite. Margaret Thatcher’s main policy decision on the NHS was to improve productivity by improving management and introducing an internal market for hospital care. Her ideas culminated in GP fundholding, whereby GPs could choose to hold real budgets and buy non-urgent hospital and community services.
GP fundholding was abolished in 1998 by the incoming Labour government. How ironic if a Thatcherite Health Secretary was to follow in Frank Dobson’s footsteps.