Oh, behave. I got some grief for saying on a previous blog that some of the criticism of health reform was a bit “hysterical.” I felt a little chastened. I now feel utterly justified.

I just did a Google search for “NHS Arab Spring” which gave me almost 1,000,000 results. I saw the phrase used in the Health Service Journal a few months back but turned a blind eye. The actual Arab Spring was in the news at the time. It was an easy analogy. No harm done. But now the analogy is everywhere.  And it’s mostly referring to a summit of Royal Colleges and the BMA this week to trash talk the health bill. more…

There are about 38,000 primary care contracts. They are worth over £12 billion. All of them are going to be the responsibility of the National Commissioning Board. By 2013 every PCT cluster will have had to scrutinise every contract, blow the dust off the ones that no one has looked at in years, and make sure they are fit for purpose. Then begins the task of creating greater convergence as to how these contracts are managed. more…

Four years ago I participated in scenario planning. The document that emerged is as relevant today as it was then – perhaps because it was looking “Over the Horizon,” taking a ten year view and considering plausible alternative futures for health care. We envisaged four scenarios: Fools Gold, Swimming Upstream, Red Arrows,  and A Tale of Two Citizens. The document gives the detail and you can probably guess what Fool’s Gold and a Tale of Two Citizens encompass. Swimming Upstream and Red Arrows envisaged differing levels of professional and public engagement in improving health and care. It was a fascinating exercise which taught me a lot about reading signals in the constant noise that surrounds us. more…

Talk to almost any public health specialist and they’ll express their biggest concern about the current NHS reforms in England as fragmentation of the public health service. To understand why fragmentation is a bad thing, we first need to know what it is that could be broken up. 

Public health has traditionally consisted of three main domains of practice.  more…

The government’s decision to consult with stakeholders during this pause in the passage of the Health and Social Care Bill through parliament creates an opportunity to revisit the problems the bill is intended to address. more…

In a recent letter Sir David Nicholson began to make clearer how he sees the NHS commissioning board and GP commissioners working together. It is a very important letter and warrants reading very carefully. The appointment of Sir David as the Chief Executive designate of the NHS commissioning board, late last year, seemed to signal that government had realised that management of a health system, through such considerable reforms at a time of severe economic challenge, required some continuity, standardisation, and grip. more…

“Competition in health care should be tactical not ideological.” That was the main message from a recent debate on “Competition versus integration in the NHS” organised by the Cambridge Health Network and the King’s Fund.

 In case you haven’t heard of the Cambridge Health Network, it might crudely and unkindly be described as the opposition to Keep Our NHS Public. It’s heavy on private sector people, many of them instinctive believers in competition in expensive suits, but increasing numbers of public sector people turn up because the network has such good meetings—and “nibbles.” Indeed, people from Keep our NHS Public were there and the first to jump up and voice their opinions. more…

As we wrestle with uncertain futures, financial stringencies, and retaining a focus on ensuring services continue to get delivered, there is a creeping realisation that something is missing.

There is a bill before Parliament which details, in jargon that defeats me, the changes to the structures for commissioning. It lays out the way the system will be regulated and steered towards the new dawn. At its heart, at the core of this radical change, is the premise GPs will be willing and eager to pick up the challenge being laid at their feet. Why will they?

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This is about the 13th reorganisation I’ve seen in my 3 decades as a GP. Up until now I’ve put it all down to the fact that politicians can’t resist “fiddling,” and if we called all managers administrators instead, they’d administer rather than think they too have to introduce change for change’s sake or to prop up their egos. However, this “reorganisation” is far more sinister as the label “NHS” will not be in any way applicable afterwards. more…