Wednesday, 24 June 2015

Bureaucracy stifling English general practice

The Bishop of Chester's contribution to the opening question of Monday's House of Lords session was:

My Lords, I declare inside information, in that my daughter is a trainee GP. I asked her about these issues last night. In Cheshire and Wirral there are vacant training places with no GP trainees to take them. On asking her why people did not want to go into general practice, she said that it is the growing burden of bureaucracy and administration. What do the Government plan to do about that?

This is further evidence for Dr Phil Hammond's criticism, written as M.D. in the last Private Eye:

M.D. takes a simple view on NHS reform: the perfect structure doesn't exist in any organisation, least of all something as complex as the NHS, and it can be profoundly damaging to keep reorganising in the hope of finding it. 

The side effects of the ill-judged Health and Social Care Act have been so severe that even lawyers are blowing the whistle to the "Eye". As one put it: "I get so angry when the government says it's reduced NHS bureaucracy. It might have cut the number of managers but the bureaucracy has mushroomed after Lansley's Act. For example, to run community services out of a GP practice used to be simple - a single lease arrangement and contract between the GPs and the primary care trust (PCT). Now the PCT commissioning powers have transferred to the clinical commissioning group (CCG). The PCT's interest as tenant transfers to NHS Property Service Limited (NHSPS). NHSPS is now the direct landlord of the provider of the service and the commissioning contract is with CCG. so now there are four parties to the arrangement to provide simple community services from the GP premises  - the GPs, the CCG, NSHPS and the provider. [...] With each added party, there are more hoops to jump through, more people on the email trails, more people at the meetings, more approval processes, more professional fees, more time wasted and greater delay."

Conservatives will no doubt blame Liberal Democrats, and in particular Liberal Democrat peers, for introducing extra checks and balances as the Health and Social Care Bill was amended. But they were only necessary to prevent the privatisation which was enabled by the Lansley plan. (Why this was allowed to be unleashed in contravention not only of all the party manifestos but also the coalition agreement has yet to be explained.) The Liberal Democrat manifesto commitment had been to take out a layer of bureaucracy from the NHS in England without sacrificing its public service principles.

As far as I know, we have escaped the worst of this in Wales - but perhaps if any Welsh GPs are reading this, they can put me right.

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