The plans for the NHS in the White Paper from the UK’s new Secretary of State for Health, Andrew Lansley, are courting some pretty unfavourable remarks from a range of commentators.
The White Paper is scary: scrapping top-down commissioners like Strategic Health Authorities and Primary Care Trusts (PCTs) and replacing them with Consortia of GPs. PCTs have become specialists in commissioning health services and currently hold the vast NHS budgets, while GPs are doctors who traditionally refer people to services but have not held big budgets to buy or commission them. So steep learning curves all round. I can understand the ideology, and the plans are nothing if not imaginative, but I’m instinctively twitchy about undertaking such a huge and risky revolution without first having amassed a decent evidence base around whether it works and how to implement the change. I don’t count the Tories 1990s foray into GP fundholding. I’d prefer some fully evaluated local pilots between now and 2012.
But, regardless of Lansley’s detractors, charities will have to adapt. Many of our charity friends have fostered close relationships with PCTs. They might have direct contractual relationships with them to deliver services such as Core Arts’ musical and artistic activities for people with mental health problems, or the Brandon Centre’s therapies for young people. Or, charities might have been working with PCTs to improve services. Macmillan Cancer Support’s work to improve care pathways for people with cancer (and reduce costs for the NHS) is a case in point. But with no Primary Care Trusts, charities will need new tactics.
Although interacting with GPs will be new territory for many charities, I think there are opportunities. The Gold Standards Framework (GSF) story holds inspirational lessons. GSF helps GPs to plan and manage the last year (roughly) of a person’s life: by planning ahead symptoms are controlled better and unnecessary hospital admissions avoided. GSF was initiated by a GP, Dr Keri Thomas, and between 1998-2001 was incubated and evaluated by Macmillan. It was rapidly returned to the NHS—so not strictly-speaking a charity—but Dr Thomas is a classic social entrepreneur that a charity chief executive could emulate. Once evaluated, GSF was rolled out through a cascading GP training programme, and has become mainstream practice within the NHS. And through the GSF After Death Analysis Tool—NB funded by a private donor via NPC—it is collecting some super data about whether GSF works and how it can be improved.
So it is possible to win over the GP audience to your cause: but offering solutions, getting evidence-based endorsement for them, and coming up with a mechanism for roll out, eg, training, will all be needed. More practically, though, my hunch is that a lot of the PCT personnel will resurface as practice managers in the new GP consortia, so don’t abandon your personal relationships yet…