A Conservative majority means no more turning upside down for the NHS. Clinical Commissioning Groups can proceed full steam ahead, especially with their task of commissioning primary care and extending local services outside hospital. It also means that the primary care focused model of out of hospital services becomes the preferred model and that predatory foundation trusts will need to listen more to their clinical commissioners and their local primary care providers if they wish to survive in the new world. It also means that Simon Stevens gets his £8bn. That’s the good news.
What is the downside? Will privatisation run rife to the benefit of shareholders rather than patients? That seems unlikely as our own clinicians are now the commissioners and they will be increasingly wary with the failure of private providers of both hospital services and general practice and will scrutinise proposals from the private sector all the more carefully. Nor is it likely that the government will have much of an axe to grind as the emphasis moves from secondary care waiting times to the imperative of cost effectiveness within a limited NHS budget. Even so, commissioners will still be able to look for new providers when their current providers are not either listening or up to it. That is surely right?
The sticking point will be the guarantees of 7/7 access to general practice and same day access for the elderly. With a declining GP share of the NHS budget and declining GP workforce this will only be deliverable by working with general practice to extend the workforce and define what is appropriate access to what will always be a limited resource. CCGs, NHS England, Department of Health and the new government and secretary of state have their work cut out. Finances will be tight. If David Cameron keeps his pledge of “one nation” then it seems the founding principles of the NHS remain intact and the debate for the next few months will be a constructive one about how we can get most for less.