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Joined-up thinking?

7 July 2010

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Supervising Editor
Management in Practice

So, the general election dealt us a double whammy – not only a new government but, in the words of Deputy Prime Minister Nick Clegg, “a new kind of government”. Will the Conservative/Liberal Democrat coalition be able to navigate the potential minefield of its different mindsets?

For practice managers, the need for continual compromise in the best interests of the public will be more than familiar – juggling GP partners’ business interests alongside the demands of both patients and the primary care trust could now be the perfect primer to a ministerial career.

Not that there’s a need for that anymore, of course. Prime Minister David Cameron has already invited us “to join the government of Britain” in his party’s election manifesto. Could this mean practice managers will have more say in the delivery of primary care – or will it mean patients will demand more from their GP services than ever before?

In the current climate, it’s difficult to be optimistic about the next few years, change or no change. It was hard not to be struck by the contrast of David Cameron’s arrival in Downing Street with that of Tony Blair in 1997. While Mr Blair made his entrance on a bright day to the welcome of a euphoric crowd, Mr Cameron’s solemn first speech as Prime Minister was set against a dark evening backdrop on a cold and cloudy day.

The meteorological difference sadly signifies a parallel contrast in the prospects for public services. Buoyed by a steadily prosperous economy, Tony Blair’s government was able to embark on an unprecedented surge in NHS spending. While the Conservatives have promised a year on year real-term increase in NHS spending over the next five years, the financial climate today is of course far harsher. Faced with a budget deficit of more than £160bn, the Con/Lib Dem (Con/Dem?) government will have to make severe cuts that will inevitably impact severely on the health service.

The Royal College of Nursing has already warned that the need to find up to £20bn of “efficiency savings” in the NHS means thousands of jobs will be axed, and could even signal a return “to the days of hospital trolleys in corridors and year long waits for operations”.(1) The reality is that there will be little sunshine ahead, even with the positive aspirations of a young new government.

It is of course too early to outline exactly how general practice will change under the auspices of Andrew Lansley, the new Secretary of State for Health. This issue of Management of Practice was published too late to include any detail (I have the luxury of writing this column long after the other articles were submitted, and even at the time of writing it’s just a week since Cameron took office).

However, Mr Lansley has signalled decisive changes to the following key areas:

  • GPs will be given more power, with control of real budgets and commissioning responsibility. Many will favour this – but some GPs say they don’t want the hassle that this entails.
  • The Quality and Outcomes Framework (QOF) will be retained, although altered. Details are sketchy so far, but it’s likely that QOF will form a smaller proportion of practices’ income.
  • Practice boundaries will be extended or even scrapped – a plan favoured by both the Conservatives and the Liberal Democrats. This will incur much opposition from practice professionals of course – we have already seen a volley of protest on the MiP website.(2)
  • Patients will be able to see a GP seven days a week between 8am–8pm. This will probably involve giving GPs responsibility to commission out-of-hours care, rather than forcing practices to stay open during these times. Again, full details are yet to emerge on these proposals, and it will doubtless involve tense negotiation with the GPs’ Committee – the British Medical Association has said the idea is “a luxury that we may not be able to afford in these financially straightened times.”

Indeed, finance will have a hold over policy like never before. As Mr Lansley said in his first speech as Health Secretary: “The current financial crisis requires leadership and highly effective management … to cut costs of what we do now and to enable us to meet increased demands and to improve quality and  outcomes.”

So, no pressure on you guys then.

1.  See…
2. See