NHS Reforms: A Practice Manager’s View

Philip Horsfield is Practice Manager at Village Green Surgery in Wallsend and a long-standing client of Sintons. Here, he discusses how the recent reforms in the NHS have led to “chaos” in primary care.

I would not fancy being the guy who gets the job of organising the office Christmas Party at the Department of Health this year. Let’s face it, this has not been a good year for them. Despite their best efforts to cascade blame downwards to NHS management further down the food chain, there must be nobody at Richmond House who will look back on 2013 and says “job well done”.

Well, almost nobody.

The only office at the Department of Health with reason to be cheerful at the moment must be the one which deals preparations for privatisation. I am sure they already have the Bollinger on ice ready for their Christmas party.

Recently I wrote the following letter to The Times. It was published on 8 July 2013:

I realise that as the practice manager of a GP surgery, my voice counts for nothing, but could I issue the following request to the political establishment:
Please will you just leave us alone to treat patients, and stop “reforming” us.

It seems to be a requirement of the job that every Health Secretary reinvents the wheel of NHS management. The routine stupidity of this can be exampled with one form (a Prem2 form) which I have to fill in on a bi-yearly basis.
In 2007 I sent to to the “Contractor Services Agency”.
In 2009 this had been replaced, and I sent it to the “Family Health Services Agency”.
In 2011 this had been replaced, and I sent it to the “Primary Care Services Agency”.
In 2013 this had been replaced, and I sent it to “NHS England”.

Labour is already outlining plans to “reform” the NHS again should it get into power.
Please can someone just stop, and let us see some patients. Has nobody correlated failings in NHS management with the fact that nobody ever gets to do the same job for more than a couple of years?

The biggest favour any Health Secretary could do the NHS would be to set out a mandatory minimum time gap between “reforms” of ten years.

As I wrote that letter, I was conflicted in my plea for no more reforms. The reason for this is simple. Despite my belief that rolling reform is damaging the NHS and killing patients, I am convinced that the recent re-structure has done so much damage to service delivery that even I would have difficulty arguing that it should not be reformed again.
In a recent conversation with a colleague connected to the GMC, he admitted that in hindsight the recently abolished Primary Care Trusts would have been fine if the government had simply increased the amount of clinical input into strategic decision making. There was no need for the root and branch destruction of NHS Management which has now taken place. No need unless you are setting up structures ideally suited to privatisation.

The new management structure of primary care in the NHS is so obscure that the Kings Fund has created an animated cartoon which attempts to explain how it works. However, if you view from the point of view of a private provider hoping to tender for the running of a chunk of the management work, it makes perfect sense. That little department with the Bollinger on ice has achieved every one of its key performance indicators!

Sadly, the chaos which is now unfolding is a very real issue. So, how much credibility will I lose if I write back to The Times to recant my previous plea for no more reforms?

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