{"id":9304,"date":"2011-06-09T15:03:06","date_gmt":"2011-06-09T14:03:06","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=9304"},"modified":"2011-06-09T15:03:06","modified_gmt":"2011-06-09T14:03:06","slug":"edward-davies-nhs-reforms-be-careful-what-you-wish-for","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2011\/06\/09\/edward-davies-nhs-reforms-be-careful-what-you-wish-for\/","title":{"rendered":"Edward Davies: NHS Reforms – be careful what you wish for"},"content":{"rendered":"

\"Edward David Cameron\u2019s speech on NHS reform this week should have marked a substantial victory for doctors\u2019 leaders. In recent months they have been even more outspoken than usual in their opposition to whatever it is the government\u2019s saying this week and David Cameron let them know he was all ears. \u201cI\u2019ve heard the passion of our\u2026 doctors,\u201d \u201cI\u2019ve heard doctors tell me,\u201d \u201cI\u2019ve heard our hospital doctors,\u201d \u201cDoctors said we should,\u201d \u201cIt’s what doctors and nurses want.\u201d \u201cHow high should I jump?\u201d Only one of those may be fictional.<\/p>\n

Let\u2019s be in no doubt that Mr Cameron has a bit of a thing for doctors. So why shouldn\u2019t doctors, or indeed the public, be loading the PM or themselves with plaudits after he announced several concessions at their request?<\/p>\n

Take the reinstatement of waiting targets. \u201cYes, we’ll continue to measure how long people are kept waiting in A&E. Nurses and doctors said we should – and that’s what we’re doing.\u201d Is that the sound of a BMA fist punching the air with delight? No, what you are hearing is the dull crack of palm slapping forehead. Because you only have to go back one government to hear doctors saying the direct opposite.<\/p>\n

This report from the BBC is just a few years old<\/a>: \u201cBut throughout recent years, government targets – including those for waiting and A&E treatment – have been attacked for distorting clinical priorities. Jonathan Fielden, chairman of the British Medical Association’s (BMA) consultants committee, said: \u2018The biggest problem is that the government has not engaged with doctors. “They have imposed these targets from the centre which have interfered with clinical judgement.\u2019\u201d<\/p>\n

But there are arguments both ways for these targets so maybe that\u2019s an unkind example.<\/p>\n

What about the other splendid victory on scrapping the ridiculously tight 2013 deadline on forming GP consortia. There\u2019s near unanimity on that. \u201cI’ve heard the concern that the direction is right but the pace is too fast,\u201d said Mr Cameron, all ears again. \u201cWhat if some places, some practices aren’t ready? Will we just let them flounder as others prosper? No. We will make sure local commissioning only goes ahead when groups of GPs are good and ready.\u201d<\/p>\n

So GPs can take their foot off the gas. Phew. No pressure. We\u2019ll sign up when we\u2019re ready. All is well. Except we\u2019ve been here before with practice based commissioning and an awful lot of GPs didn\u2019t feel ready to commission. In fact they never felt ready. In fact the lack of urgency around the situation was so profound that it led David Colin-Thome, the government\u2019s own Primary Care Tsar to describe the policy as \u201ca corpse not for resuscitation.\u201d As any editor will tell you, no deadlines means no journal. If you set a tight deadline, people may bitch, curse, and even fail to meet it, but at least there is an expectation to work to.<\/p>\n

But actually it\u2019s worse than that. Some areas are already doing GP commissioning very well thank you, while others do not as yet even have any provisional structures in place. What we can expect is some savvy and committed GPs to run with this while others hang back and wait for the next government reshuffle. There will be a two tier system of commissioning for patients. Sound familiar? Fundholding anyone?<\/p>\n

And throughout the shenanigans that have played out over the 12 months since Lansley presented his White Paper, there has been a sword of Damocles hanging over the health secretary\u2019s head. Whether it\u2019s at a nursing conference passing a vote of no confidence in him<\/a> or a doctors\u2019 one narrowly failing to do so<\/a>, you really don\u2019t have to look far to find voices demanding he be sacked. But who would replace him? Enter stage right Stephen Dorrell.<\/p>\n

If Lansley should go Mr Dorrell now appears liked and hotly tipped to fill the seat<\/a> \u2013 indeed even Dorrell himself wouldn\u2019t reject the notion last week<\/a>.<\/p>\n

So just how short is the human memory? Rewind to the eve of 1997\u2019s general election and Tony Blair staked his entire election on the soundbite \u201c24 hours to save the NHS.\u201d The following day\u2019s landslide victory, the most seats the Labour Party had ever held, showed him a keen judge of the public mood. And who was the health secretary from whose clutches the service needed saving? The very same Stephen Dorrell.<\/p>\n

This is not a critique of the just criticism thrown at the bill nor any particular advocacy for it, but one of its few merits was the nod to some historical problems in the NHS and an attempt to correct them \u2013 the two- tiered system of fundholding, the distorted priorities of targets. So before the UK sashays elegantly back into waiting times, fundholding, and the mid-90s in general, we might just want to be a little bit nuanced about what we wish for.<\/p>\n

Edward Davies<\/strong> is editor, BMJ<\/em> Careers<\/p>\n","protected":false},"excerpt":{"rendered":"

David Cameron\u2019s speech on NHS reform this week should have marked a substantial victory for doctors\u2019 leaders. In recent months they have been even more outspoken than usual in their […]<\/p>\n

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