International report

Britain gives doctors more power in new NHS

LONDON – The new coalition government in the United Kingdom, elected in May, has announced a far-reaching re-organization of healthcare in England, one that would hand much more decision-making and control to physicians.

Under the new plan, up to 75 percent of the $160 billion spent annually by the National Health Service in England would be given directly to doctor-run organizations, which would in turn buy services from hospitals and other providers on behalf of their patients.

It’s seen as the most mind-boggling shake-up in British healthcare in decades, and perhaps the most radical since the NHS was created in 1948.

The aim is to make British healthcare more effective and efficient by taking control out of the hands of bureaucrats – such as health authority and hospital managers – and giving it to the people who actually know what’s best for their patients, the doctors themselves.

The scheme would also shrink the bureaucracy, as part of the government’s aim to chop $30 billion in “efficiency savings” in the health budget by 2014 and to reduce administrative costs by 45 percent. Tens of thousands of jobs would be lost because layers of bureaucracy would be abolished.

The health secretary, Andrew Lansley (pictured), also promised to put more power in the hands of patients. Currently, how and where patients are treated, and by whom, is largely determined by decisions made by 150 entities known as primary care trusts – all of which would be abolished under the plan, with some of those choices going to patients.

It would also abolish many current government-set targets, like limits on how long patients have to wait for treatment. The plan, with many elements that need legislative approval to be enacted, applies only to England; other parts of Britain have separate systems.

The government announced the proposals this month. Reactions to them range from pleased to highly skeptical.

Many critics say that the plans are far too ambitious, particularly in the short period of time allotted, and they doubt that general practitioners are the right people to decide how the healthcare budget should be spent. Currently, the 150 primary care trusts make most of those decisions. Under the proposals, general practitioners would band together in regional consortia to buy services from hospitals and other providers.

It is likely that many such groups would have to spend money to hire outside managers to manage their budgets and negotiate with the providers, thus canceling out some of the savings.

David Furness, head of strategic development at the Social Market Foundation, a study group, said that under the plan, every general practitioner in London would, in effect, be responsible for a $3.4 million budget. “It’s like getting your waiter to manage a restaurant,” Mr. Furness said. “The government is saying that GPs know what the patient wants, just the way a waiter knows what you want to eat. But a waiter isn’t necessarily any good at ordering stock, managing the premises, talking to the chef – why would they be? They’re waiters.”

But advocacy groups for general practitioners welcomed the proposals. “One of the great attractions of this is that it will be able to focus on what local people need,” said Prof. Steve Field, chairman of the Royal College of General Practitioners, which represents about 40,000 of the 50,000 general practitioners in the country. “This is about clinicians taking responsibility for making these decisions.”

Dr. Richard Vautrey, deputy chairman of the general practitioner committee at the British Medical Association, said general practitioners had long felt there were “far too many bureaucratic hurdles to leap” in the system, impeding communication. “In many places, the communication between GPs and consultants in hospitals has become fragmented and distant,” he said.

The plan would also require all National Health Service hospitals to become “foundation trusts,” enterprises that are independent of health service control and accountable to an independent regulator (some hospitals currently operate in this fashion). This would result in a further loss of jobs, health care unions say, and also open the door to further privatization of the service.

Posted July 29, 2010