Does a longer working week equate to a better trained doctor or a more tired doctor?
The Royal College of Surgeons recently stated that according to a survey of 980 surgeons in the UK, the 48-hour week in accordance with European Working Time Regulations has resulted in patients in hospitals being less safe than they were a year ago.
The abolition of practice boundaries is one of those policy ideas that is so ‘crazy’, as the chairman of the RCGP put it, that it’s difficult to believe that government ministers actually had the nerve to suggest it.
A rather gloomy mood seems to be engulfing the NHS at the moment. The general consensus is that things are looking pretty bleak in terms of finances, post 2011.
NHS managers are racking their brains for ways to rein in spending – apparently ‘nothing is off limits’ in the quest to save a few bob. What all this means for GPs and nurses remains to be seen, but it seems inevitable that PCTs and NHS trusts will be doing their utmost to get more for less.
‘Productivity’ and ‘efficiency’ are the new buzzwords, and I fear frontline clinicians will get sick of hearing the phrase ‘it’s about working smarter, not harder’ – it is sure to get a run out at every meeting you attend in the coming months.
Everyone, it seems, is prepared for the worst.
Except health secretary Andy Burnham.
In an interview in the Daily Mirror yesterday, Mr Burnham made the bold claim that ‘Labour will never cut the NHS budget’. The government is not talking about cuts, apparently – it’s ‘not in our lexicon’, the new health secretary says. Phew. That’s alright then. No need to worry.
But he must have had his fingers crossed behind his back when he said this.
When practice-based commissioning launched in 2005 it was instantly hailed as the solution to all the NHS’s ills in England.
The term ‘PBC’ quickly slipped into the DoH’s lexicon of acronyms, as ministers claimed it would unleash innovation among frontline staff, giving them the opportunity to shape how services were delivered. This, they said, would improve patient care and save huge sums of cash.
So here we are in 2008 and little progress has been made, according to a report published today by the King’s Fund. The think tank says that in some areas PBC has completely ground to a halt.
This is not that surprising, considering that when the policy was launched there was little indication of how it would actually work in practice. There was an idealistic vision of a future utopian health service, but little about the nitty-gritty of actually achieving it.
The DoH, just embarking on its mission to decentralise the NHS and devolve decisions/any accountability to local trusts, left it up to PCTs to decide how things would work. This, coupled with some very vague overall aims and objectives, clearly made progress impossible.
Then there was the issue of ‘indicative budgets’. When PBC launched, the NHS was in the grip of huge financial deficits. PCTs were looking to claw back funds from wherever possible, so it is not surprising that GPs were wary about whether they would ever see the benefits of any money they saved.
Indeed, the King’s Fund is recommending that government must give real budgets to commissioning groups if it is serious about getting PBC off the ground. This is a sensible idea, and would provide a proper incentive for commissioning groups, as is the idea to develop a ‘matrix’ model that acknowledges the different levels of commissioning.
It is hard to argue against the sentiments behind PBC. Giving GPs and other frontline staff including nurses the ability to redesign services is surely to be encouraged. Clinicians have a much better idea about how services can be improved than office-bound managers and number crunchers at the PCT and this, therefore, means better care for patients.
More needs to be done to make PBC work. The DoH needs to go back to the drawing board and come up with a plan to move things forward. As the King’s Fund points out, there is enthusiasm for local commissioning out there, but it is dwindling. It would be a real shame if that was lost and PBC was consigned to the DoH’s ‘failed policy’ scrapheap.
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