NHS GP Comissioning – Gain or Pain?

In Public sector, UK productivity on May 5, 2011 by Tim Aikens

The UK National Health Service (NHS) is embarking on a major change.  The key objectives are to improve the quality of care provided and at the same time deliver more for less.  The plan is to transfer control of funding from Primary Care Trusts (PCTs, mostly run out of hospitals) to General Practitioner (GP) Consortia which are groups of local doctor practices.  The big debate is whether this will deliver or be an abject failure.  I am not going to go into the politics of this but rather  look at some of the issues from a pure delivery perspective.

In order to do what they did, the PCTs needed a significant infrastructure to manage the financial and supply aspects of running a very large multibillion pound business.  The GP consortia will be smaller and more of them, so their average size will be around half of a PCT.  But they will still need to manage the process of  ‘health care delivery’.  So if the new approach is to work, I believe three things need to happen:

1.  The management process will need to be more effective and the ‘bureaucracy’ that existed in the PCTs dismantled.
2. GPs will need to be very effective in their choice of care given such that it is both cost AND care effective (and efficient).
3. GPs will have to become business people as well as doctors.

This exercise is a huge transformation. It concerns over 1.4 million people employed by the NHS and countless others.  How is it going to work?

One thing is sure, there will have to be massive change and things will have to be done differently.  The same old mantra.  Yet if all that happens is that bureaucrats are moved from a PCT to a GP consortium and many of the processes are also transferred, little is going to change.  Perhaps the biggest obstacle is changing the culture of the NHS.  How do you get 1.4 million people to be more focused on care and efficiency rather than management targets and cost shifting (from one centre to another – it happens a lot in hospitals. e.g if A&E can move a patient to a ward before X-Ray the cost of the X-Ray goes on the wards costs not A&E! – regardless of whether this is the best clinical result for the patient).  So here are my tips for change that will improve the chances of a good result.

1.  In setting up GP Consortia, they need to get an external view.  Find people who have no NHS background, but do have a background in performance improvement and quality.  This goes back to the old example of SouthWest Airlines seeking advice from Formula 1 car racing on vehicle turnaround!
2. Be real about what you are trying to do.  There is a real need to cut cost and move more of the spend to patient care.  This needs to be made very clear to everyone and not camouflaged as many politicians attempt to do.
3.  Communicate.  There are 1.4 million people to get through to.  This will take an awful lot of communication and it will have to be repeated.
4. Lead from the front.  GPs, the Consortia Managers and their teams will have to demonstrate their commitment to the principal objectives.  If they don’t the whole process will fail.
5. Be clear about what is expected from everyone.  The most important aspect of this is being clear about expected changes in behaviour.  If behaviour does not change, little else will.  Those 1.4 million staff need some very clear guidance on what behavioural change is expected of them.  They also need to know that they will get help in making those changes.

There’s not really that much new here from many other major change programmes.  The concern I have is that the NHS has tried to change before and little has worked.  In large measure it is because they have not addressed the five topics above.  I hope for all of us in the UK that there is success this time around!


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