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Health White Paper
Initial assessment
Dr Irene Bainbridge reports
23rd of July 2010
As expected, Health Secretary Andrew Lansley last week announced plans for a fundamental and far-reaching reform of the NHS, in the Health White Paper entitled "Equity and Excellence : liberating the NHS"
Importantly it is open to consultation until October3rd.
The transfer of power- and responsibility- from state to community is at its heart. GP s will be expected to form consortia for commissioning services as well as providing primary care.
Crucial to this will be the willingness and ability of GP s to participate in the process. There will be financial incentives and also some penalties.
It proposes to ruthlessly cut back on echelons of bureaucracy and management, including SHAs and PCTs by 2013.Great economies are anticipated. However, increased efficiency may come at a price- the disbanding of these pivotal statutory bodies cannot happen without huge upheaval and there will be chaos unless what takes their place is carefully thought through and phased in over a period of time. Similarly, if local authorities are to take on the task of improving Public Health outcomes, they will need considerable support. As dispensing doctors we would do well to look at engaging with the Public Health Service, since it is well known that morbidity and outcomes in rural areas depend heavily on access to medical services, some of which we are able to provide by subsidies from our dispensing income.
Targets and endless data collection are to be abolished and replaced by measures of outcomes and the setting of standards of care. NICE is to play a major and more independent role in appraising services and treatments . They will be setting 150 quality standards of patient care over the next 5 years. Perhaps we could consider introducing our own kitemarks based on our Dispensing Guidance and dispenser training.
"Payment by Results" will give patient feedback an important role in rating standards of care..The frequently voiced satisfaction of patients with dispensing practices will be harnessed to good purpose in these ratings .
"Putting Patients First" and freeing patient choice are recurring and laudable motifs in the plan.
Dispensing doctors are likely to take a particular interest in this. If it means what it says, and patient choice is truly paramount, and is to be opened to "any willing provider", it does indeed, offer possibilities beneficial to patients and the NHS..(Of course, a potential downside to this is the abolition of practice boundaries.)
Competition between a mixed bag of (licensed) providers clearly forms part of the proposals though much more detail is needed here to assess the implications.
At the same time, it would be highly desirable to see measures which encourage co-operation between the professions for the benefit of patients.
Dispensing doctors and pharmacists working together as they do in some areas, is a prime example which could be developed further.
However,for no clearly stated reason, the proposals have excluded community pharmacy, dentistry and ophthalmic services from the commissioning process and in my view, if we want to see a joined up NHS ,all services should be subject to the same scrutiny, controls and standard-setting.
In the next few weeks we will be hearing more about the new proposals, as there is much more work to be done..
We will then have an opportunity, in the ensuing consultation, to draw on our expertise in areas such as medicines management and provision of rural medical services. We must help steer this courageous and risky process in the best direction.
DDA Online will be publishing more on the White Paper soon.