An interesting metaphor indeed, and certainly contains a grain of truth.
The issue for me is whether I continue to express opinions that a critical of the whole commissioning process as a front for cash control, blame shifting and creeping privatisation; or whether I accept that this is the only show in town, and knuckle down and get on with it.I shall probably do both, and give my colleagues who are leading this process full support.
15 comments:
JD = great gp + decent human being trying his best
Oh, it's the oldest trick in the book pointing out perceived deficiencies in the critic rather than the thing being criticised.
Put another way - some people might be less alarmed by Lansley's expensive folly if it is only 'old fogies' who bother to object to it?
I'm sure these kinds of superficial, and ill directed put downs will not stop you from producing more cracking posts like this one?
http://thejobbingdoctor.blogspot.com/2011/01/hello-politicians.html
Remember if you are an ostro-dinosaur by your own estimation there are many thousand similar creatures?
Ignore the critics - they are making the classic mistake of playing the man instead of the argument.
Keep posting your incisive posts - you're just about the only GP who seems to be standing up publicly against these daft reforms!
This bill has a long way to go. It has to go through the Lords, where the Conservatives do not have a majority, even with the Lib Dems added on. Hopefully their Lordships will gut the bill as it deserves. Don't give up on this too soon. Politicians always rely on you to do that; that's why you shouldn't.
Never let it be forgotten that the revered and honorary Professor Steve Field was one of the principal architects of this bill. It's a shame that GPs weren't more critical of the proposals at an earlier stage.
I think I was responsible for the ostrich comparisons. Nothing personal. But you are currently seeming to ignore the many problems in the NHS. You can't paper over the cracks - particularly in the care of the mentally ill - by quoting one anecdote about successful brain surgery. I just wish you would all stop nailing your colours to doctrinal totem poles. Privatisation is not intrinsically evil and nationalisation is not intrinsically good. Good Heath care delivery needs to take the best of both worlds. JD, don't spoil it all be being politically blinkered. Rise above politics and look at outcome. Mawkish appeals like this to your tame acolytes serve only to demean your normally persuasive writing.
Realist
Anon,
We are looking at the facts. Fact 1; we've been down this road before with fundholding. It didn't work then and it won't work now. Fact 2; we have wasted billions on an IT system that doesn't work. Accenture got a £63 million slap on the wrist when it should have been fined £1.2 billion for walking away from the contract. Fact 3; private companies do not operate under normal market rules in the NHS. What company do you know that allows its competitors to use its premises and its staff to make a profit, while making a loss itself? Yet that's what happens everyday in the NHS with its intake of private patients. If private companies want to set up private hospitals with their own staff, blood banks, ambulance services, ancillary services and train their own doctors, fine. Good luck to them. But insisting that the market uses public money to fund its own profits isn't on. We've just been through that with the banks. We don't want to go through it with the NHS.
Julie, there are so many factual errors in your comment that I hardly know where to start. The IT debacle happened because NHS purchasers are incompetent and threw bad money after bad. Had an NHS IT contract been put out to open market competitive tender, with performance penalties, as it would have been if, say, Tesco had been the purchaser, it would have been very different. Treating private patients within the NHS generates huge revenues for the NHS. The fact that the NHS is incompetently run is not a reason for cutting off this large income stream. Julie, you are like the Increasingly silent JD (who sadly now seems only to function as a chat-room thread starter) - well meaning but blinkered. Please, please stop being doctrinaire and look at the facts.
Realist
I guess if you keep kicking a dog, its going to get suspicious of any doggy treats you leave for it, no matter how tasty they may seem.
JD has 30 years as a GP and has seen reforms come and go. You can hardly blame him or the rest of us for being wary. we're just waiting for yet another kicking.
Apologoes for talking in metaphors but as you have alluded to, there just isn't room here for anything more detailed! :-)
Connecting for Health was a top-directed project by the DoH, led by Richard Granger, who happened to hire his pals Accenture (who already had a bad record in America) to do it. And I note you've dodged the main point. We have had GP commissioning before in the form of fundholding. It doubled admin costs from 6% to 13%. Why are you convinced it's going to work this time round and if you're so contemptous of NHS purchasers, what do you think is going to be achieved by doubling their number from 152 PCTs to 300 consortia?
Julie, Richard Granger was an incompetent toss pot who would not have been allowed near a budget or anything to do with management in the private sector. Try googling him; read all the Private Eye investigations and so on. Only an incompetent purchaser like the NHS would have let him loose. So what's your point?
As to GP fundholding, well, my experience of it as a patient of a fundholding practice was that it worked very well indeed. Then Dobson/Blair pulled the plug on it and suddenly my GP was left with no choice at all as to where she sent me.
I do not for a moment claim that GP commissioning is the answer to all the NHS problems, but I do believe that GPs will be better purchasers of health care than the overpromoted typists who run the PCTs. And this time, for the first time ever in the NHS, there will I hope be wholesale redundancies as the over paid, over pensioned are sacked. They will have difficultly getting the same salaries - or indeed any job at all - in the private sector.
Realist
Anon,
If commissioning goes ahead you will be left with the kind of tosspots that messed up the IT programme. It will be CareUK, Assura, Serco, Atos , Netcare etc etc. They will cherrypick the least expensive patients and leave the NHS with the most expensive. That is how risk pooling works. We've had these people up here, like Netcare who took £15 million upfront to do hip and knee operations at Stracathro and then refused to do ops on people with co -morbidities. At least they were honest - they had no facilities to deal with complications in an operation unlike the nearby NHS hospitals. But that begs the question; what use are private companies in the service sector? What are they doing, apart from making themselves a profit at our expense?
With regard to the IT programme, there were penalties written into the contract. It's just that Richard Granger decided not to apply them as he was pals with Accenture. That's what you're dealing with.
I see that Anon/Realist noted that the NHS doesn't do the greatest job with the mentally ill. Even if we were to accept that, what on earth makes him/her think the private sector would do a better one?
It strikes me that mental illness is not something the private sector is likely to be able to make a big profit on, again with certain cherry-picked exceptions like offering rapid CBT for minor depression in the otherwise healthy and employed, or US-style psychotherapy for the well-insured.
Just what will make the private sector embrace care of psychogeriatric patients, homeless alcoholic schizophrenics, people with personality disorders that mean they are almost unemployable, repeat offending drug users etc etc...? The only way will presumably be to offer them a fat bribe from the public purse, which from my perspective seems totally self-defeating.
Has anyone noticed that GPs are actually part and parcel of the private sector?
One rule for us and one for them?
'Has anyone noticed that GPs are actually part and parcel of the private sector?'
Yes, in the sense that Tesco and your local shop are both private businesses. That doesn't mean that you would want Tesco to buy up all your local shops and take over their business. Oops, they've already done that. Wondered why there was tumbleweed blowing down our high street.
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