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Who should control NHS funds?

08:23 UK time, Monday, 12 July 2010

Ministers are setting out plans to give GPs far more power within the NHS in England. Should doctors control the purse strings?

The government wants doctors to club together in consortia to take charge of £70bn for mental health, hospital and community services.

It would represent a major structural change but some experts have questioned whether the profession has the skills to take on such a responsibility.

Do you work in the medical profession? Should doctors be given more financial power? Will this mean more paperwork and less patient time for GPs? How would you restructure the NHS?

This debate is now closed. Thank you for your comments.

Comments

Page 1 of 8

  • Comment number 1.

    Oh no not another initative that will waste billions? It is one initative after another within the NHS, and no Government is prepared to let one be introduced properly before they introduce another. The NHS is continually used as a political football.

  • Comment number 2.

    I have grave concerns regarding giving GPs control of the NHS budget. GPs may say they want control, but when they are given it will they be able to handle the responsibility is the real question. I believe than my own GP doesn't even like his patients. If I was seriously ill I have serious doubts regarding the care I would receive. If the GP had to pay for my hospital care I fear I would not receive it. As for nurses all I have to say is they are no little Florence Nightingales. Very many of them couldn't care less about patients and if you are older then God help you. No Mr Health Minister, think again. PCT are a long way from perfect, but they just may be better than your suggestions.

  • Comment number 3.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 4.

    Having talked to GPs about this it seems the most popular solution for them will be to use commercial organisations to administer their funds. So this is another way in which the NHS is being slowly privatised.

  • Comment number 5.

    Can they do a worse job than some of the NHS trust managers who have subsequently left the profession with a massive golden handshake, despite the fact that they are leaving under a cloud, and a trust is left with the appalling consequences of their inadequate management? At least they have a better understanding of what is necessary and what is not.

  • Comment number 6.

    More movement away from central and state control and more shift to the people who the service is for. Sorry UNISON, the NHS was NOT started for YOU

  • Comment number 7.

    Just what the NHS needs.

    Another bout of radical reorganisation.

    'doctors to club together in consortia to take charge of £70bn for mental health, hospital and community services'.

    I had no idea that part of a doctors 6 year training period included the efficient allocation of massive budgets.

  • Comment number 8.

    This is just one absurd suggestion after another by our new Health Secretary. He seems to have no sense of practicality or priority, or indeed the "real world" of hospitals and patients. Penalising hospitals for "deliberate" readmissions, dismissing efforts at tackling public diet and food quality, transferring control of the health service as a whole to a professional group as disparate and nebulous as General Practitioners (good as they are at the job they trained for).

    These views sound at best naive and misguided, at worst they are contemptuous and potentially harmful, both to the public and the medical profession. Andrew Lansley's own website boasts about the Public Sector credentials of his family. Unfortunately he has none of his own to draw on and this is becoming painfully apparent day by day. I'm afraid it's three strikes and you're out as far as I'm concerned.

  • Comment number 9.

    They should have the courage to means test nhs services and create more cost effective system that reflects todays realities.

  • Comment number 10.

    This is all about TORY COST CUTTING - nothing else!!
    People should have no doubt that this the continuation of the privatisation of the NHS and another potential 2 tier system!
    They tried to do this before in the 90s - remember??
    It was called "GP Fundholding" championed by none other than Ken Clarke and it helped to start the destruction of the NHS - only to be halted by Blair and New Labour in 1997.
    What this does is hand power to people who JUST DON'T know anything about holding funds - and these people are already OVERPAYED (GPs get an average £150K a year - far more than they are remotely worth!!
    Yes, there is a problem with the relationship between GPs and PCTs but you cannot assume that GPs have the knowledge of areas like Mental Health - THEY DON'T!!!
    Just at the time when GPs should be retrained or trained in areas like Mental Health - they need to up their game in this area - they are being handed more work which they are neither capable or able to do!
    What has Lansley being doing for the last 12 years?
    No, this is just a cost cutting and privatisation Tory agenda - nothing else!

  • Comment number 11.

    I agree with post #1 about the NHS used as political football. I also think that giving GPs more power is good in theory, but in practice could result in their focus being shifted away from patient care to admin, which is basically what this is.
    I don't understand why this coalition government is trying to privatise everything in this country. Surely my country (USA) is a great example of how this seriously fails the people.

  • Comment number 12.

    What about some out of the box thinking?

    Doctors used to run the NHS budget, they couldn't cope because they are doctors not accountants. So they tended to ensure doctors were looked after.

    So managers were given the power, but they can't make decisions. So they employ more managers, and endless meetings are held, before making a decision. The blame then can be spread when it goes wrong.

    A lean, efficient system based on the needs of servics users, run by those with the balls to make decisions and take resposability for them.

    Not a lot to ask for is it?


  • Comment number 13.

    English NHS funds should be raised and controlled by an English parliament elected by the English people working in collective interest of the English people. Scottish, Welsh and Northern Irish MPs should have no say on the English NHS.

    There should be no "regional" differences in services - one health service for all.

  • Comment number 14.

    The NHS is desparately in need of of reform to make it more efficient and less wasteful, however, GP's tend to be Jack's of all trades and masters of none. The majority of GP's that I have met would be incapable of managing these funds due to either lack of competence or lack of the will to take on this additional task because they are either too lazy or too busy. I don't expect to see any improvement in the NHS through implementing this badly thought through scheme.

  • Comment number 15.

    The Tories opposed the creation of the NHS, the only reasons(according to Keith Joseph) they didn't abolish in 1951, when they won the election, was it's popularity, when Thatcher won again in 1987, Tory MPs were calling for the NHS to be abolished. The have always hated the 'socialist' ethos of the NHS and have always sought a way to privatise by stealth.
    GPs aren't financial managers, the coalition's objective is to bring the private sector into the provision of NHS services, this is the first step.
    The big US 'HealthCare' coporations are circling around this proposal, just watch how this develops.

  • Comment number 16.

    What, trust GPs with more immediate patient care. I know of at least 2 practices in London that are just pill pushers and would not want them to decide my care.
    There was a thing to set up polyclinics too but they didn't happen, because, so the local PCT said..there is no money to open and run one.
    This is a contuence of Margaret Thatcher's privatisation of the NHS and it will go downhill from now if this closure of specialist services in hospitals happens.
    As for saving lives, the treatment ad care will cost much more than it does now.

  • Comment number 17.

    Of course you are right 4. At 08:57am on 12 Jul 2010, Anne_M.

    Everything the tory do is to privatise, their supporters crave for it and what will be left is a monopoly for the big boys, just like the banks and financial institutions. Insurance companies are very pleased that the tory are back in power even though nulabour pandered to the capitalist needs (how on earth can some say that nulabour was a socialist party are either liars or idiots).

    As for doctors...I owe my life to the medical profession but there are certain doctors that have ruined my life.

  • Comment number 18.

    "The G.Ps should not be in control, of the massive amount of taxpayers money" Next thing to happen will be for them to dump, all the patients that cost them money,{ Old and long term sick } and do private work on the side i.e minor oprations' to save money for the N.H.S.? My G.P.has too many other business, shops and {Buy to let propery} to be able to do the paper work needed to do it well. This would only save money in the short term, because this would create many more long term serious ill people as there would not be any treatment, {Cost cutting} in the early part of any illness or disease.

  • Comment number 19.

    If the structure is incorrect then 'control of budgets' will have little or no impact. Someone needs to grasp the nettle by looking at which model has served the public best in previous incarnations, and this needs to be from bottom (i.e. the patient) upwards. This is public money and not an invitation to every Jo, Pat and Sam to get rich.

    All doctors, nurses and ancillary staff must be respected but at the head of concern must be the patient. Should 'patients' have more say in the system?

  • Comment number 20.

    Another one of those where forethought, planning and vision seems to be lacking - by driving NHS priorities through centrally and politically motivated targets you end-up with a system dominated by managers whose only priority is meeting those targets with no regard to clinical need or the actual patients involved - a one-size fits all conveyor belt. By driving the NHS by ”market forces” and immediate needs coming up from GPs you will end up with a system that copes with what happened yesterday, but is constantly fighting to keep up with today, and without anticipating the needs of tomorrow - a general problem with allowing “market forces” to determine any market. While I don't agree with a centrally planned behemoth; and the pot of cash isn’t big enough to cope with today’s requirements, our leaders and experts do need to sit down, without political motivation, and work out what we what we want the NHS to be and what the NHS will need, not today, but in 10 or 20 years time, and start putting these measures in place, even if that planning means there is in the pot for treatment today.

  • Comment number 21.

    GPs already have a lot of control over NHS funds, it's called Practice Based Commissioning, and it allows for effective power sharing between local GP practices and the PCTs who support the wider area. This system is a good way to ensure that all needs are met.

    The problem with this new policy is that the needs of the people are not going to change so the same services will be commissioned, the government will require all the same paperwork and assurance and the provider trusts will not be impacted at all apart from shuffling their paperwork in a different direction. In short, costs will be incurred to set up this new structure but the service to the patient will remain the same. So why bother?

  • Comment number 22.

    I agree totally with comment number 1 posted by David.
    The NHS is always the punchbag for any incoming government. Cameron and his lapdog are no different.

    They should concentrate more on why the money is not reaching the wards Doctors, Nurses and Patients. Which is easy, get rid of the overabundance of unecessary overmanned management sitting behind thier desks doing nothing but taking a fat slice of the NHS budget for their unwarranted wages.

  • Comment number 23.

    This is an idea that sounds good on the surface but in reality will cause more problems than it will solve. GP's have neither the time nor the skills to manage budgets on this scale - do we really want our highly trained and experienced doctors wasting half their time trying to work out where money should be allocated ? No, they should be treating patients.

    There needs to be input from GP's and other medical professionals (why only GP's ? Why not any of the hospital based doctors who surely have a much better understanding of their own fields of expertise ?) but the management of monies on this scale has to be done by people who understand how such finance levels operate and can make a dispassionate decision with regards to difficult fuding decisions. As has been previously mentioned, this has been tried before and all that happened was that GP's approved funding for any medical need and then wondered at the end of the year why they were massively over budget.

    It does strike me that such a scheme is more of a neat government 'blame-shifting' excercise - now you will not be able to blame central government when whatever bit of NHS funding that actually affects you gets cut (we all seem to agree that spending needs to be reduced and there is a wide consensus that such cuts should fall in all the bits of the NHS that don't affect us personally.....), they will just point at your GP and blame them.

    A bit like asking the public where the cuts should land.

  • Comment number 24.

    3. Ron C wrote:
    Anything that will sideline slim or castrate the overpaid unnecessary bloated management in the NHS.
    ---------------------------------------------------------------
    And who brought in the 'overpaid unnecessary bloated management'; yes the torees started it under the mad woman.

    So we have come full circle. First we had business managers, then we had independant hospitals, then hospital trusts, the story goes on and on.

    Its a wonder alan sugar or jamie olivar havn't been asked to run the show.

    I've no objection to anyone running the NHS as long as they do it right.

    That eliminates most groups:

    Politicians: Only want the NHS when it has good news, labour reduced this to a numbers game, shorter waiting times - wonderful! (only the rest of the NHS was allowed to go to pot).

    Business managers: Only see themselves as the CEO of a large multi-million pound business, people - they are such a pain.

    Doctors: How do I advance my career to get into private practice and make serious money.

    Nurses: How do I get more pay when EVERYONE thinks I deserve it, but it never happens.

    Patients: I do not care what it costs, I do not care that it was my failure to look after my own health that made me ill - I want treatment NOW!

    Families: I want the best for my loved ones and I want the hospital to be at the end of my street with free parking so I can breeze in and out, bringing a load of bugs and bacteria with me, when I feel like it.

  • Comment number 25.

    What about asking PATIENTS what THEY WANT?!
    When I went to a PCT meeting recently to discuss a new Mental Health Strategy - after listening to a what seemed like a pre-ordained PCT strategy, I then asked if they had properly consulted our patients and service users and there was a big silence!!
    I believe that IT'S ESSENTIAL that we involve patient service groups at the heart of commissioning - they're the people who use the services and should almost be making the decisions NOT GPs OR PCTs!!!
    PCTs have failed to do the job they were designed for (in my view) BUT we cannot assume that GPs are the right people to commission things like Mental Health services using NHS money, as this is an area most of them know very little about!?
    It's also not particualrly fair on them (?), so I would look towards the charities like MIND, IMAGINE , RETHINK and the NHS Trusts etc who are much closer to the needs of patients and service users as a basis for planning services. After all, these organisations already have good proven track records and outcomes!

  • Comment number 26.

    Lots of comments seem to forget that GPs operate as a business - they don't do anything for nothing. This will not get rid of the bloated bureaucracy and too many NHS managers. GP fundholding was tried before and failed. This just shows that David Cameron is no different to any other Tory. All he is doing is putting back everything that was in place in the days of Maggie. Sad that he's got no new ideas of his own!

  • Comment number 27.

    PLEASE, NO, NO NO.

    Several family members are health professionals in the NHS and remember the Andrew Lansley effect last time.

    This has to be THE most extreme right wing version ever. It's untested anywhere in the world, and must be piloted first for patient safety. Just because the government CAN do this - it DOESN'T make it right.

    This is absolutely NOT just about cutting layers of wasteful management, and we are all being seriously misled.

  • Comment number 28.

    Three points.

    First , do doctors have sufficient knowledge and skills to manage these budgets? What happens when the answer is "no"?

    Second, I assume that GPs will be even more likely to refer patients to private providers , since the cost of treatment will not come from their budget. The cost of private care will soar.

    Third, and this is the most important point, I want doctors to be more available to patients. Longer surgery hours, weekend surgeries, home visits carried out by the GP not some (often incompetent with dubious language skills who want to do it all on the phone) out of hours service they hire in to do parts of their job. Will someone please explain how giving GPs more non-medical responsibilities is not going to result in exactly the opposite- less GP time for patient care?


    What I can see here is doctors becoming business managers, rarely getting near a patient and subcontracting all the medical work to a group of nurses and bought-in cheap doctors on short stays who regardless of competence never get to know a patient. Maybe they'll even adopt the same ludicrous triage system in place in many hospitals where you have to get assessed by a nurse before you're allowed near a doctor. Is that the sort of GP service you have in mind Mr Cameron?

  • Comment number 29.

    It has been apparent over the past few years that doctors are most adept at looking after the interests of doctors.This latest proposal looks like an exercise to get G.Ps as allies in order to introduce swingeing cuts planned for the N.H S.

  • Comment number 30.

    So what if the nhs is ptivatised? If it meant real terms service improvements and reduce the cost to the tax payer, whats the problem. It should be looked at objectively.

  • Comment number 31.

    The govt could make huge savings just by

    - eliminating wasteful bureaucracy
    - limiting the care offered (no more sex changes or IVF on the NHS, for example)
    - charging for GP appointments
    - making more people pay for prescriptions

    But radical restructuring right now seems wrong. It will cost a lot of money, and entail turmoil, diverting attention away for providing medical care and reducing costs.

    In future, I'd advocate the dismantling of the NHS - it's way past sell-by date. Let's go to European style social insurance instead. But not right now.

  • Comment number 32.

    Just another COST CUTTING agenda for a Tory led government!!
    Don't forget these people actually enjoy cutting public services even if they don't need to, because it's in their blood!!
    That's totally irresponsible and the powerless Liberal Democrats won't have much of a voice in this will they??
    This coalition is already dead in the water, as far as I'm concerned.
    We did NOT elect Cameron and now, they are just going to do their own thing as usual, leaving mass redundancies and job losses in the NHS too!!
    That's what this destructive policy will do - just like GP Fundholding did/tried to do in the 1990s!!
    This is a dangerous situation for the government.

  • Comment number 33.

    This proposal to devolve NHS management to GPS, each having his/her own budget, requires a serious re-think. The GPs of my aquaintance are only too glad to get away with a quick consultation followed by a scribbled prescription. I would not want them to get involved in serious policy making.

  • Comment number 34.

    With over 40,000 GP's on an average salary of £115,000 ,£30,000 more than the average Hospital Registrar (an equally well trained Doctor) and more than any Nurse however high their seniority ,qualifications, or responsibility. It is also higher than the rate of pay of a General or Admiral in the Armed forces or an Assistant Chief Constable, Chief Fire Officer or Head of Paramedic Services in the civilian emergency services.

    GP's are by far the single largest overpaid section in the public sector.

    The average German GP earns around £50,000 per year. They are as well qualified and work as hard as their UK counterparts, Nurses and Hospital Doctors in Germany have salaries similar to their UK counterparts.


    Taking all of the above into account the Condemned government in it's "infinite wisdom" is going to hand over the cheque book to the very group who are flagrantly overpaid.

    Barmy!!!!!!

  • Comment number 35.

    I can understand the logic behind this but have no faith that it will improve anything from a patient point of view. I also doubt there will be a significant saving to the NHS overall. Removing a layer of bureaucracy looks attractive but every GP practice will take on more non-medical staff to manage the system so will there be a net saving? At the practice we use it is a lottery which doctor you see and some have no time for older patients and with £££'s signs flashing when you walk in even more scope for contempt and neglect. The logic of a change looks good but I am concerned what will result or is more neglect the hidden objective of the exercise.

  • Comment number 36.

    Last year, I fell extremely ill due to chicken pox. NHS direct advised me to have a doctor to check me out. The doctor refused until I challenged and told her I would report her to BMA. Eventually she came and was extremely shocked at what she was staring at. She prescribed medication but it was too late. Soon after she left, I was send to the hospital by the ambulance and was hospitalised. So, if we are to give the GPs more power, we have to pray we will be in perfect healthy condition. Getting appointments is already an issue. This will give the doctors more excuses about being overworked and of course to demand more money for their ever shortening working hours. When will the government ever realise the GPs are the problems and not the problem solvers!

  • Comment number 37.

    Well this is the next step because GP's will only have healthy people on their books. no elderly no disabled and no sick, as the government have already set this in motion ie winter fule payments scrapped so the elderly and disabled will switch off their heating in winter as unaffordable ie eliminated by hypothermia, pensions reduced state pensions reduced By 20% housing benefits slashed. attendance allowance slashed and others so that it is impossible to live and of course pension age raised to 70 in hopes that no one reaches that age. an example is that someone on a basic state pension of 495 per month has to pay 320 per month in social housing and 156 in council tax with no benefits you can see that they will not be able to buy food or heating or care. this is wwhat the government are doing to everyone just to save a few bob, and GP's already paractice discrimination by most time refusing to have anything to do with the elderly saying they are too old for any treatment this happens here in scotland so god help the rest of the UK

  • Comment number 38.

    I agree with comment 2. Doctors are overpaid already and can only see them awarding themselves a pay rise first. At my doctors surgery the doctor does not write anything down while you are there, just stares at you, this has led to them Not putting down important information, for example when I broke my foot about three years ago I was told to rest it, I then heard another crack at a later date, went to ask the doc if it was worse and was told probably!! None of this was put on my notes. In the end after many weeks {a long story} saw a consultant whose first words were "why wasn't I sent sooner!! I had to have an operation consisting of a bone graft, pinning and wiring and was not allowed to put my foot down for over 7 weeks. {very painful} I developed "back" problems over time which again was not recorded. I have now changed to a different {fairly new} doctor at the surgery who straight away referred me to physio treatment. This all happened over three years or so and I was not allowed to go back to work at all as I developed RSD in my foot {a bone wasting disease} I was in a private ward for almost two days great but was then transferred to normal ward.What a difference. The nurses were just as in comment 2 but leaving "bells" to ring, telling people who needed help to the toilets they would have wait until after lunch they had already waited twenty minutes. This is just a small example of a great many faults. I phoned the hospital within two weeks of leaving it to complain, was told there was not a complaints system procedure. With PALS help I wrote letters of complain to the Gloucestershire hospital and the doctor. The hospital dismissed my complaint and did not reply to my second letter at all!! The practice nurse tried to be helpful, the doctor did not at all. With this kind of attitude and the NHS managers getting I assume huge salaries to do nothing at all I wonder who should be in charge of finances. Get rid of the Trust Managers for a start would save a huge amount of money. I do think getting Matrons back in charge might help as regards nursing, as many of the nurses at present do not have to answer to anyone while they are at work as there does not seem to be a permanent member of staff at any time, a Matron would be in total control and make sure cleanliness and nursing are as they should be making sure money is well spent.

  • Comment number 39.

    As it is doctors are the last people you would want to run funding.They can only just be bothered to see their own patients and give them a few minutes of time.Most I have come across only want to do the minimum to satisfy government and letting them loose on NHS funds would be a total disaster.It would be back to the bad old days of months or years to see a consultant and a great many rejections for state of the art medicine if its too expensive in the doctors opinion.

  • Comment number 40.

    Doctors are not above fraud & embezzlement, so there needs to be a powerful watchdog.

  • Comment number 41.

    What a great idea and while we're at it handover the social security budget to the unemployed, handover the MP's expenses budget for them to manage, the possibilities are endless and it will all work so well.
    Doh!

  • Comment number 42.

    Some years ago GPs were `fund holding` which allowed them to `buy` services for their patients - this seemed to work very well and that was before GP contacts were changed -- why not go back to that with the doctors doing it a part of their present contracts? I find that many doctors` attitudes have changed since these new contracts- they have become very greedy whilst enjoying greatly enhanced working conditions. I remember doctors stating that after a full day`s work they were far too tired to be able to cover nights and weekends properly but now that they can be paid for the `out of hours` service they are not too tired at all!! Who `mans` our `out of hours` service - why, our local GPs!!

    The NHS was designed to be life- saving - it will inevitably have to prioritise because of our ever-expanding population - surely life saving and pain relief procedures should be top of the list - we may have to do without those things which are not essential and do not materially affect our lives. We have to control just how many managers there are and exactly what they do -- I attended a meeting recently when we were expecting one NHS manager to attend, but THREE turned up - and one did not utter a word. If this is how they use their time (and travel expenses)is it any wonder the system is almost on its knees?

  • Comment number 43.

    ME - I'm good with money

  • Comment number 44.

    ///15. At 09:15am on 12 Jul 2010, LeftieAgitator wrote:
    The Tories opposed the creation of the NHS, the only reasons(according to Keith Joseph) they didn't abolish in 1951, when they won the election, was it's popularity, when Thatcher won again in 1987, Tory MPs were calling for the NHS to be abolished. The have always hated the 'socialist' ethos of the NHS and have always sought a way to privatise by stealth.
    GPs aren't financial managers, the coalition's objective is to bring the private sector into the provision of NHS services, this is the first step.
    The big US 'HealthCare' coporations are circling around this proposal, just watch how this develops. //

    Leftie - you might be right. But do bear in mind that the NHS is utterly crap, and that other European countries manage good, 'socialised' medical care without having a big organisation like the NHS.

    The Tory attack on the NHS might be politically motivated, but I'd suggest that any defence of it is too.

    Its defenders need to realise that it is lethally useless. Its attackers need to realise that full privatisation isn't an option either.

  • Comment number 45.

    Read posts 11, 15 & 10 which describe, in my view, the underhand agenda for this & problems it will cause. The USA private health system is a perfect example of healthcare for the wealthy rather than for everyone, which is why Obama is taking steps to change it.
    The thousands of nurses & also people in other caring/social roles, are exploited due to their commitment, passion & sense of moral responsibility. The NHS should be run responsibly and with the same committment shown by it's dedicated & hard working employees. A sense of moral responsibility should prevail - money given by us should be used wisely and not used to generate disproportionate profits for the greedy few who then have the choice and don't need to rely on community healthcare. Money & power corrupt - keep private sector, unprincipled wealth accumulation out public sector interests.

  • Comment number 46.

    When consultants ran the NHS we had 2 year waiting lists. Why would GPs do a better job? It's a backward step. There's no doubt the NHS structure has become a gravy train for professional bureauprats but GPs simply do not have the skills to manage multimillion pound budgets.

  • Comment number 47.

    Just as an aside, I spoke to a woman who had been a GP's receptionist but gave up the job after 9 months. She said, and I quote: 'I started out wanting to help people but within six months of continous whining, complaining and pointless calls I lost all concern. I would pick up the phone and tell someone, usually a pensioner, that the appointment call line didn't start for five more minutes and then put the phone down on them. I left because I didn't like the person I had become'.

    Ring a bell?

    And we are going to give these people more power?

    Are we mad?

  • Comment number 48.

    It probably should be the doctors, but they are already complaining (at least some are) that they don't have the time.
    Therefore it won't be them.
    The current health boards/trusts etc. are both too expensive (massive salaries being paid to chief executives far above their value) and out of touch (happy to charge us for parking at the hospital to see loved ones). So they are out.
    The politicians shouldn't be as they are very inclinded to direct funds to their prized areas (oh thats a Labour area... or oh thats a Conservative area.... - yes both of them do it) so they are out.
    Perhaps we need to go for a locally elected panel?

  • Comment number 49.

    Who are these experts who question the management skills of the professionals? I hope this is the first stage of a sweeping change to the delivery of publicly-funded services; and the objective should be to remove the professional managers who can do nothing else other than manage.
    The arrogance of these professional managers is sickening. They think they are so clever. Well, sack them all and see how clever they really are!

  • Comment number 50.

    It seems yet another expensive and pointless reorganisation of the NHS, a continuence of the micromanagement and interference by successive governments... who know nowt about health care, after all. It's not what they are hired for.

    But neither are GPs. Their role is to take care of their patients long-term (cradle to grave), calling in specialist assistance as and when required. They ought not to be worrying about costs, just medical need. That's what they are hired for.

    Trouble is, the whole thing has got out of hand, a convoluted maze. All these 'trusts' and other murky groups, which seem to bear no accountability to either the local community or the NHS as a whole. It's difficult to tell just what they are hired for (or by whom...).

    Go back to something straightforward. A lean central ministry with the role of providing the service, which uses demographics to determine where facilities need to be situated and hires the people to staff them directly. Owt else and someone's going to yell 'Postcode lottery' before you get your trousers on. Once said ministry has decided where there needs to be a GP surgery and hired the GPs, nurses and clerical staff necessary to run it, then the GPs take care of the people on their list and direct them to whatever other services they require.

    The key thing is to remember that the NHS is a SERVICE not a business. Yeah, it's expensive to provide a proper health care service, but I for one reckon it is a good use of the money I contribute to the public pot... indeed, it is one of the things (like education) that I contribute for, part of the social contract of us, the citizens of this country, giving the government money so that they can provide services.

  • Comment number 51.

    What we are seeing is the end of the NHS.
    Privatisation by a government that believes in those who can pay get the better health.
    This has been the goal since 1945...and now it's within sight!
    For all you who believe this to be a good thing I wish you good health because the private sector does not value those who take from their profits.
    You don't count if you don't have the money....and make sure that you have plenty because the private health companies will bleed you of all that you have and then stop treatment.
    I can show you a bill from a US hospital that itemises every last thing....even down to paperclips!

  • Comment number 52.

    Unfortunatly, as I am in Wales we still are governed by nulabour in health, and they are slowly doing the opposite building one big central health board by merging all the smaller ones together.
    I like this idea to give doctors control of our health provision, but I would go one step further and move control right back to the person, give each eligable person a card - an NHS, national insurance, whatever you like card so the individual has complete control of their health provision. Then you really could tell the snooty receptionists to stick their excuses where the sun don't shine, and go and get the medical provision we, as a population, has paid for.

  • Comment number 53.

    Yet another exclusion exercise. To make the NHS accountable a paperwork trail was commenced. This requires additional managers to audit the results. No extra staff for the extra paperwork required by staff on the floor. Hospitals used to be run by a matron. Now we have ward managers reporting to matrons reporting to upper managers reporting to regional managers reporting to central managers reporting to the board of directors. Then on the other hand it is now going to be G.P's holding the purse strings and making the decision on where the money is spent. If you end up with a serious illness you had better hope you have a good relationship with your G.P.. Given the option, we would all look after our family and friends and put their needs before the needs of the community. G.P's are only human and would do the same. We now have brilliant community treatment that allows for the early discharge of patients that allows for them to have their final phase of recovery occur in their own home. This however means that the patients on the wards are those too ill to go home early. The percentage of people with serious illness has therefore increased on the ward with the same number of nurses, as before early discharge was possible, to care for these patients. We are told that there has been an increase in the number of nurses employed but, it hasn't been reflected on the wards where the care is provided. The NHS has become a massive top heavy money sponge but it cannot be replaced by your local G.P. When you go to your G.P and the problem is bigger than a few pills, they refer you to a specialist. Refer the NHS to a separate board of specialists who have control of all NHS Trusts, with a blanket rule. Get rid of the top heavy management and bring back matrons that are more than just a figurehead. We already have enough trouble booking in to see our G.P. Take another day out of their week to attend their consortium meetings and it would be quicker to fly to and from Europe to see a doctor.

  • Comment number 54.

    I'd like to know how much the government expects to save using this method, and where they expect to save it from.

    Otherwise they're focusing on the wrong stuff.
    Doesn't this government realise we're spending 135% of tax revenue?

    Try doing that on your wages, see how long you last.

  • Comment number 55.

    Maternity Wards at Tesco, Heart Surgery performed at the local Odean theatre, Eye Opts at Spec Savers!

    I have a vision of the future - its corporatism, its privatised and its go a Logo! Corporate Brands in the NHS......Mmmmm lovely!

    Oh - and as for Free Schools - Think Education delivered by Mcdonalds and Burger King......terrific

  • Comment number 56.

    Giving control to GP's is like giving the keys to the drugs cabinet to an addict. In spite of many criticisms a massive business such as healthcare needs Managers who understand money, not amateurism. A parallel is with the transport system of Hampshire Police, for thirty years the management of the fleet has been by 'Managers', trained professionals. When investigated by the Audit Commission the system was found to be the most efficient both in monetary terms and more importantly in providing the tools for the job.
    As someone else has mentioned, all that GP's can do is hire in private companies to do the work. The 'initiative' is yet another example of Politics wasting Taxpayers money, for Party doctrinal purposes.

  • Comment number 57.

    The NHS should be controlled by an Accountant, someone with clear understanding of money, I can assure you the first thing to go would be the multi layered management structure.

  • Comment number 58.

    It's a fundamental error to have the person advising treatment to be responsible for the funding of that treatment. It puts doctors in a difficult position, when they know finances are running low they will be tempted to take a chance. In many cases they will be right but there are always those cases where they get it wrong
    My best friend went to her GP several times with symptoms which he dismissed as trivial. One time he was away and she saw another more cautious man who sent her straight for further investigation. Too late her cancer had advanced to far to be treated
    How many doctors are financially astute, I thought they were busy enough without this extra responsibility
    We were told at the election that the NHS was safe with the Tories at the same time Cameron was having meetings with the private health companies and Nurses for Reform. This is the first step towards privatisation. It will be presnted in a favourable light but we should stand and be counted now. The treatment advisors and the providers of finance should be kept separate. No doctor should have his or her judgement clouded by financial concerns.

  • Comment number 59.

    You might think that devolving funds to GPs will get rid of layers of NHS bureaucracy. Not so. It might get rid of some but will replace it with more. Here is why.

    When budgets and many powers were devolved to schools under the last Tory government it sounded great, schools being able to make local decisions using cash in much more sensible and relevant ways. OK so far, except of course with this freedom came responsibility, a whole lot of extra work, non-educational tasks for head teachers, a vast accountability paper chase and protocol, and new layers of bureaucracy.

    My wife is a primary school head teacher with a budget of about £3 million to manage. She has complained for a long time now that she is head of admin rather than being a head teacher. She wants to be driving the school forward educationally and making strategic financial decisions only. At long last she has found a bit of money to pay for a business manager. She has slightly reduced educational staff to help pay for it, but can now hand over financial and premises management to a qualified person. This will be in addition to her receptionist and admin assistant. More bureaucracy? Well yes. Less money spent on education? Well yes?

    I can just see how this scenario will be played out at GP practices all over the country. GPs will need to be accountable for their new responsibility, so the scrutiny infrastructure and paperwork will have to increase. Doctors trained to be clinicians will have to become financial experts or employ non-clinicians to be additional business and finance managers. More bureaucracy? Well yes. More money spent on bureaucracy? Well yes. Where will they find the money? The medical budget? Well yes.

    AND, of course NHS trusts will still have to maintain a large bureaucracy to interface between GPs and hospitals and to ensure smooth running, best value for money and all of that.

    My prediction? 20 years of chaos and the vast expense that always goes with change, also stressed-out doctors leaving the NHS in droves.

    Ah! I just realised..... Tory plan for back door privatisation.

  • Comment number 60.

    Ok we have had the polical rants about mad women leaders etc, but lets look at it.
    When the NHS was formed who ran it? Was it teams of Managers or the Doctors. It actually was the Doctors in local hospitals accountable to a County Wide Department of Health.
    What we have now is PCT's who are responsible for the spend. How many are there in your county?
    It is not easy to find but in mine I have counted 4 so far without the Ambulance Service, sorry NHS Trust, and Mental Health.
    That is an aweful lot of managers who create a massive bureacracy that doesn't really account to anyone locally. Yes I know they are supposed to but in reallity just try and get some not normal drugs and see who says no and how easily you can get them to change their minds.
    GPs running it would be a good move.

  • Comment number 61.

    • 4. At 08:57am on 12 Jul 2010, Anne_M wrote:
    Having talked to GPs about this it seems the most popular solution for them will be to use commercial organisations to administer their funds. So this is another way in which the NHS is being slowly privatised.

    +++++++++++++++++++++++++++++++++++++++++++++++++
    Having a company administer a budget is hardly privatisation. Doctors do not clean their own office and surgery, a cleaner does from a commercial company, the electrician that checks the fire alarm and emergency lighting every month are from commercial companies.

    Having a budget manager is hardly a big deal and clearly you don’t understand anything of how a large organisation like the NHS works.

  • Comment number 62.

    If you have a medical condition which looks like being expensive to treat or you have a baby with a serious birth defect you will have the added worry of trying to find a GP willing to take you on his books. They will only want healthy patients so they can avoid any critism of over spending on their budget. Exactly what happens with private health care companies

  • Comment number 63.

    BTW. Go to Department of Health website to get a 'feel' of what that Department is all about? You will quickly discover that there are more press officers on that site than there are health professionals in most A&E departments.

    The Department of Health website provides NO information about any hierarchy of those ministers responsible for the DoH - simply it's all about Mr Lansley? Why is that?

    Fairness, openness and transparency of coalition government sounds rather hollow if you don't know which minister to contact over your NHS concerns?

    To compare and contrast - the Department of Education shows their hierarchy of ministers, political affiliation plus their duties and responsibilities within that Ministry. This should be a 'gold standard' of all Ministry departments.

  • Comment number 64.

    All this user's posts have been removed.Why?

  • Comment number 65.

    THe Bloke: "Leftie - you might be right. But do bear in mind that the NHS is utterly crap, and that other European countries manage good, 'socialised' medical care without having a big organisation like the NHS."
    Most of Europe opted for an insurance based system for their Health Care systems, where patients paid for treatment through their insurance. The government regulate the insurance scheme to ensure costs are kept under control. It's not a free market 'free for all' as in the US(where 25% of the population have no access to health care). When the NHS was setup is was set up as 'pay as you go' system', because the nation's health was so poor.
    My concern is that our political class always look at the US for their social policies. The NHS needs to be reformed but not on the US model ,there is good argument for adopting one of the European models.This coalition's instincts is to adopt the US model.
    I want a 24/7 GP service, good local hospitals, I don't want 'centres of excellence', which in practice means 'areas of mediocrity' for everyone else.

  • Comment number 66.

    To answer the Last part of the question only:- Much of the structure of the NHS was in place before the invention of the motor vehicle, much was in place in the mid-1920's. Hospitals were built to serve the local people, who would mostly walk or travel by 'bus. Three miles equalted to an hours walking. We have many small Hospital units scattered across vast areas simply because they were there.
    Near to me is a massive newly built state of the art Hospital. By Ambulance it is 10 minutes, by car around 11 minutes. Even by bus it is less than I hour. I also have access to three other Hospital type units within the same area. None of the three has A&E facilities, they each have no function that cannot be carried out at the main Hospital. Their ONLY benefit seems to be that they save a few people a car journey. Whenever they are threatened with closure there is an outcry that OLD people would be deprived of a Local facility, even though the travelling time is minutes not hours.
    When I have been sick in the past I have not cared where the Hospital was, I actually lived equidistant from three main hospitals, passing by several 'Local' units on my ambulance ride. I had never met the Doctor who treated me, I was happy to make use of his skills. I was treated well in the Hospital, my family were within 40 minutes travelling for visits. In all a good experience.

    My point is that each of the numerous outposts in the NHS cost large sums to run and maintain, it would be better to cut down in the number used. Many sites are on prime sites in towns and could be leased out for income. We need to rationalise the NHS, cut down on the number of sites and change the way in which we expect delivery of service. AN in depth survey is needed of ALL NHS sites to ensure that they give value for money, and provide services that are necessary.

  • Comment number 67.

    I'm glad I live in Scotland.

    My guess is that many GPs won't want this responsibility; they will take the view that they trained to be doctors to heal people, not to be administrators. Some, though, will accept this role. These doctors will spend more and more of their time on the job of managing and less and less on seeing patients, so extra doctors will be needed. In the long run more money will be spent on administration as a result of these changes than is presently spent on the management and bureaucracy that everyone seems to complain about just now.

  • Comment number 68.

    Hey, this is a great idea. Each GP surgery will now hire new Directors of Finance, Strategy, Marketing, PR etc all on 6 figure salaries plus more accountants, managers etc. The GPs will want paying more (on top of the huge rise they got a few years ago for doing LESS work) so we can already see another million a year added to the costs of each GP surgery. That'll save lots and improve services, won't it?

  • Comment number 69.

    Better the money is in the control of medical people than in the control of people who know nothing of the business they are meant to be running.

    I can't see Doctors wasting csh on art installations.

  • Comment number 70.

    This is just as I feared the NHS is going to be privatised, the Tories have always hated the NHS and all it stood for and now there is nothing to stand in their way to privatise it.

    I firmly believe that the funds should always remain in the control of the government and that private companies should have no say in the NHS because their overiding aim is to make money and that is not what the NHS was set up for.

    The NHS stands for National Health Service it is there and always has been there to serve the population of the country not to make money out of them. The NHS was the greatest thing that ever happened for the ordinary people in this country and it's typical that it would be the Tories and Liberals who would dismantle it.

    Ever since Thatcher introduced the market system into the NHS it has been fighting off privatisation but now with this disasterous government, who have already done so much damage to the country in only two months, the writing is firmly on the wall. The NHS that so many ordinary people in the country rely on will be gone within this parliament.

  • Comment number 71.

    in this day and age when people's needs are dependant on charity there is a recognised committment for gps to do their duty by serving the communities in which they practice.
    Dr Quango will emerge from his surgery dressed in top hat and tails after leaving his white coat behind, step into his new rolls and speed off to the
    city bank and demand to be seen, not as a local medic, but as a government treasury inspector of health,he will then issue new government orders on N H S
    patients'needs,after gaining a salute from the top banker,he will then freeze some poor child's daily ration of medicine by withdrawing the value added propotion of his own surgeries financial output,so that, the repected G P can
    play politics with two of his new patients Clagg & Cameron City Chemists gone bust.

  • Comment number 72.

    Basically, hello pre-1945, bye bye NHS, it's life Jim, but not as we know it!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

  • Comment number 73.

    THE big problem, a huge one, with this proposal is lack of testing. Yet again politicians are proposing major change to the NHS based entirely on intellectual thought.

    I applauded Andrew Lansley's scrapping of the NHS London plan. Not because the Darzi or Poly Clinics on which it is based are not a good idea, the best thing since sliced bread even, but because the model hasn't been adequately tested. Yes, there are a few Poly Clinics around, but they're just too new to know if they achieve their objectives.

    To introduce this major, huge, re-orgaisation without any real 'on the ground' testing of the model amounts to monumental stupidity.

    There are 151 PCTs in England, and all GP practices are 'tied' to one PCT. Why not try out the model with 2 or 3 PCTs first? If it doesn't work then not too much harm done. If there are issues or problems, resolve them whilst still relatively small scale. If it's a success then roll out to the other PCTs in a controlled, phased way.

  • Comment number 74.

    Fine as long as the GPs are qualified and paid no extra penny for doing this. But this is not going to be the case. So look forward to the world of privatisation.

  • Comment number 75.

    I heard this morning that only 10% of GPs have the skills to run such a system. I also suspect that only a few actually want such a system. These changes just move the bureaucracy from one area to another. Surely what we want is GPs treating patients not looking at spread sheets. Its classical management speak if the system is not perfect don't work to find out why and fix it just change the system and it will be a few years before we find out that the new system doesn't work either.

  • Comment number 76.

    Amusing. Presumably the managerial skills to deal with contracts, poor performance, selection, accountancy etc pass osmotically into the heads of senior medics within GP consotia to allow this function. Alternately, PCT staff are decanted into these new organisations to perform the same task as they did in the PCT. There will need to be more of them as there are more consortia proposed than the current number of PCT's. Makes perfect sense to me. They could of course be setting up an ideological move towards privatisation.

    Ex PCT staff should be thinking of setting up their own Medi Admin inc in order to undercut the competition from the US. Oh, and goodbye TUPE.

  • Comment number 77.

    Will that mean less time on patient care?
    Will it mean a huge reduction of paper shufflers in the NHS, or will they shift to work for the GP's.
    The problem is too many managers and money could be saved. Will this initiative make savings and get patients operated on sooner.
    Trouble for me is that I am in Wales and these initiatives wont count over here.

  • Comment number 78.

    57. At 10:36am on 12 Jul 2010, yorkshire News wrote:
    The NHS should be controlled by an Accountant, someone with clear understanding of money, I can assure you the first thing to go would be the multi layered management structure.
    ==============================================

    There are already more accountants in the NHS than you could shake a stick at. They know the price of everything and nothing whatsoever about the nuances of running the NHS.

    They can't get their heads around people being sick and actually wanting treatment, they are more interested in the figures on their spreadsheets and balance sheets. They don't understand that people are quite often sick outside of office hours and sometimes (heaven forfend!) those people will want treatment even when the budget is running out.

    There are far too many managers in the NHS, everyone knows that, but far worse is that they are the wrong type of managers; the NHS cannot be run like a supermarket chain or a department store, at its core is people not commodities.

    Get rid of PCTs and SHAs, they're just rest homes for the incompetent. Let the GPs hold the purse strings, they are the best people to know where the money should be spent, but ensure the spending of it is overseen by a small administrative backup team which will take the paperwork away from the GPs.

  • Comment number 79.

    70. At 11:13am on 12 Jul 2010, phill wrote:
    This is just as I feared the NHS is going to be privatised, the Tories have always hated the NHS and all it stood for


    You are right why should the leaders of the Tory party care, they can afford private health care. You'd think Cameron would be more grateful to the NHS, no private health company would have taken on his son.
    The privatisation will be done slowly step by step. We have got to oppose these first steps if we care. Make no mistake the NHS is the best thing we have. The peace of mind of knowing that sickness will not cost or involve a battle with a company looking for reasons not to pay is wonderful. The fact that there is no charge to see a GP means problems are quickly spotted as patients don't put off going. So far we have paid in far more than we have received in treatment costs, and that is how it is for many but the fact that as a family we have no fear of costly treatment is wonderful and can never be underestimated. I never want my family's health to be in the hands of those looking to make a profit

  • Comment number 80.

    I know from experience how NHS GP's prefer to sit behind their desks and issue drugs. This is going to be a bonanza for the drug companies and more exploitation of the patients.

  • Comment number 81.

    This won`t work and will result in less people getting the treatment we need, as it currently stands in all hospitals, if you know the staff/doctors your shunted to the front of the queue leaving those who have sat patiently fuming because they have to wait longer
    By doing this your just playing into the doctors hands, not to mention allowing the managers to take an even bigger slice of the pie in bonuses
    As it stands the NHS recieves £1 million, by the time it gets past the managers and admins less then £100,000 goes into the actual hospitals... so the overall result of this is a bunch of millionaires taking a slice each while patients who`s paid the taxes into it to start with still don`t recieve the treatment they require

  • Comment number 82.

    The govt. needs to stop playing around with the NHS. As an example, a few years ago all sterilisation of "kits" was handled in house. Now it is sent off to an external company no doubt part owned by MP's. In this external company they need 48 hours notice, they lose kits (bearing in mind these kits are in the thousands of pounds region). Where as the old system was quick, effecient and so much better.

    Stop mucking about with the parts that aren't broken! Stop having unrelistic ideas about the NHS

  • Comment number 83.

    So now we will have GPs controlling budgets. This will result in some GPs being prepared to fund some forms of treatment such as routine scans, phsio, referral to consultants etc, and others blocking it.

    It will result in a GP lottery and depending on who you see and the state of their budgetary control will decide whether you live or die....

    GPs need to practise medicine (and be paid less for it) and the NHS should decide on budgets.

  • Comment number 84.

    "@ 9. At 09:08am on 12 Jul 2010, krokodil wrote:
    They should have the courage to means test nhs services and create more cost effective system that reflects todays realities."

    Krokodil, as someone who has paid income tax and National insurance since leaving school at 18 and have been paying tax at 40% since I reached my 30s, I find this suggestion insulting. I have been paying for the NHS for years and used it very little (I pay for private and use that whenever I can). So why using your logic should I be means tested should I need NHS treatment.

    If you want to means test, then make sure the people paying for it and their families get the full service whilst free loaders and health tourist get a basic service.

  • Comment number 85.

    When NuLabour massively increased GP's earnings it did absolutely nothing to improve the level of care I received. All that happened is that the size of the practice grew and to see the doctor of my choice on the day of my choice became impossible.

    Now the coalition aims to give them even more power and my heart sinks. I want a doctor who can identify with me as a person not some power hungry man/woman intent on building a medical empire. Gone are the days when your GP saw you as an individual with far reaching personal problems - now it is a matter of the patient having this check and that procedure in order to for the doctor to meet his 'targets'. What the sick person wants comes a very distant second.

    I would also like to mention that ny local brand new surgery is constantly vandalised and each morning the stench of drunken idiot's urine emenates from its doorway. When I suggested that some member of the staff should wash away this filth my comments were met with open eyed amazement. It is almost as if they feel it would demean them to attend to such a matter.

  • Comment number 86.

    ///32. At 09:51am on 12 Jul 2010, sledger10 wrote:
    Just another COST CUTTING agenda for a Tory led government!!
    Don't forget these people actually enjoy cutting public services even if they don't need to, because it's in their blood!!//

    Sledger - unfortunately, the NHS is vastly expensive, and scarily bad at doing its job.

    Your comments would imply that everything's fine - but it isn't. The NHS is lethally useless. That doesn't mean that the Tories are going to make it better, or even intend to.

    But the NHS is so pathetic compared to its European counterparts - and all of which seem to deliver better care, socially funded, without having a vast, inefficient NHS-style monopoly.

  • Comment number 87.

    Matron!

    Idearly no nonce Claire Raynor

  • Comment number 88.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 89.

    50. Megan wrote:

    Go back to something straightforward. A lean central ministry with the role of providing the service, which uses demographics to determine where facilities need to be situated and hires the people to staff them directly.
    ----------------------------------------------------------------------
    Yes that would proberbly work - but not for the politicians.

    Everytime the NHS gets things right people praise the doctors and nurses.

    Everytime the NHS gets something wrong - blame the politicians.

    What's in it for them?

    The NHS costs a fortune, (minimum cost - maximum demand) a significant part of government expenditure. Is it any wonder they keep changing the system?

    As long as politicians get the smelly stuff thrown at them by every member of the public with a petty gripe that 'they' are not getting the treatment they want, when they want it, do not expect the politico's to think about anyone but themselves.

    The politicians would love to privatise the NHS, all of them. But not for the ideological reasons of magot thatcher. No they just want the public off their backs.

  • Comment number 90.

    Memo to self: do NOT fall ill for the next five years.

    I'd like to think someone will do a body count of the cost in human lives and permanent health damage of converting to this system without a trial somewhere first.

    Also, I'd like someone to explain how it can possibly work without a massive increase in the postcode lottery that already exists in the NHS.

  • Comment number 91.

    If you want parity of care throughout the country then all the budgets need to be centralised. Only then can the decisions be made as to what percentage of patients will be treated for each ailment. If you want that to be 100% for all ailments then you'll need to pay more money in taxes.

    Giving budgets to GPs will not solve this problem - it will just increase the postcode lottery, whereby people will want to change GP depending on their illness, to try to ensure they get the best treatment. And GPs don't have time to take on the paperwork so they'll simply contract the administration out to private firms.

    This is how the Government tries to hoodwink us and show it's spending less money on the Civil Service. The amount that is spent on QUANGOs, consultancies, agancies and various prime or multi-activity contracts does not show on Civil Service balance sheets. This money is still being paid, but becomes hidden as there are no direct labour costs involved. And this is the next step - privatising the admin of the NHS to appear to have done the tough thing, while actually massaging the figures.

    So, who should have control of NHS budgets? I say that we should have a massive single Civil Service hub that deals with the finance of the entire Civil Service - from pay to pensions to equipment to training - and they should report back a complete balance sheet of expenditure and income. They should also have tremendous power over other firms, to offer massive contracts to (probably British) firms to supply the entire Civil Service need.

  • Comment number 92.

    The last people to give authority to spend billions of pounds are General Practioners, what on earth is the Government thinking about. These people will find it difficult to manage their own budgets let alone the budget of the NHS!!!!!!!!! My experience of primary care is not good and if I had had to depend on my GP's to get me treatment I would literally be dead! Twice - if that was possible. GP's are the source of Primary care THEY ARE NOT EXPERTS IN THE TREATMENT OF THEIR PATIENTS: we do rely on them to refer us to the experts in treatment and that reliance in my case was misplaced. There is already too much "management" in the NHS and to undo what we have YET AGAIN at goodness knows what cost, and put the soul of the NHS system into the hands of what would be amateur entrepreneurs is sheer folly. For pitys sake when will the Givernment learn to leave well alone: they know even less than the GP's; I am so angry I could cry. Our NHS has been crippled by the imposition of a variety of attempts to "privatise" the system and another one will do no more than waste billions of pounds the system has just not got to waste on bureaucracy!
    If they want to kill the NHS just kill it but no Party has the political courage to tell us to insure ourselves and rely on private health care like the USA: the NHS will not be safe in any politician's hands who think of only of the COST and not of the SERVICE!!!!!!!!!!!!!!!!!!! PLEASE LEAVE WELL ALONE CAMERON AND CLEGG GET YOUR TROOPS IN ORDER AND SORT IT OUT!

  • Comment number 93.

    I'd rather my doctor was working to cure the sick rather than being a part-time accountant.

  • Comment number 94.

    One of the biggest expenses of any funded service is the cost of controlling the money. The money wasted on creating budgets, redoing those budgets because the man at the top doesn’t like them and redoing them again because his boss doesn’t like them until several layers later we get to the Health Minister when no decision is the final outcome.

    What is so difficult about running a service (or country for that matter) where from passed history you know precisely what the next year will bring, barring some major flu outbreak that wasn’t?

    In reality it is no more difficult than doing the household accounts but that would remove the self-importance of many people and dumb down their power.

    When I was in the RAF I wanted a hole drilled in a wall of a building. I raised a request form that was signed by my Flight Sergeant, then the WO admin signed it, then the squadron adjutant then it went over to the engineering wing for approval then it was sent to the civil works department who sent someone to see me but I worked shifts so they came back again a week later, then the workers came and drilled the hole in the wrong place! I think that sums up most public systems.

  • Comment number 95.

    " 2. At 08:55am on 12 Jul 2010, PeterTigerman wrote:
    I believe than my own GP doesn't even like his patients. If I was seriously ill I have serious doubts regarding the care I would receive."

    I'm pretty certain your GP doesn't like you.... it might have something to do with the attitude you have towards him. Out of 80-odd comments so far on this page I can't find one that has anything positive to say about doctors.... its no wonder docs don't like their patients much.

  • Comment number 96.

    If this is the road to privatisation, then I say thank goodness for that. Health, like pensions, should be none of the governments doing and left to the individual to pay for their own. Those that use it, pay for it. Those that want a pension, pay for it.

    BTW, I would like all my pension contributions paid up for the past 40 years to be paid up now, save me working another 10 yrs to pay for some other buggers who couldnt be bothered to save or get a job.

  • Comment number 97.

    Since most GPs are contractors to the NHS and actually running small businesses, this is, in effect, privatisation of the NHS. GPs were against joining the NHS in the first place, and only did so because Nye Bevan worked a flanker and got the hospitals and Royal College on board and they caved in.

    Remember what happened when the government gave GPs all that money to improve their services? It went straight into their pockets. My wife found it difficult enough to convince our GP to refer her for a back problem even though she had an operation literally days afer seeing the consultant 28 years ago (which she had to jump through a lot of hoops to get). Once she was seen by a specialist this time she had an emergency operation the next day. Both times she could have been crippled because of GPs who know too little about too much.

    Access to doctors who actually know their stuff is only going to get harder.

  • Comment number 98.

    Many GP's are incompetent, unable to treat and diagnose patients accurately and now they are going to control the money, disaster!

  • Comment number 99.

    #34 "The average German GP earns around £50,000 per year. They are as well qualified and work as hard as their UK counterparts, Nurses and Hospital Doctors in Germany have salaries similar to their UK counterparts."

    You think so do you?
    http://news.bbc.co.uk/1/hi/england/8702000.stm
    "The family of a pensioner who died after he was given an overdose of painkillers by a German locum doctor has accepted £40,000 compensation.
    Daniel Ubani injected 70-year-old David Gray with 10 times the recommended daily dose of diamorphine at his home in Manea, Cambridgeshire, in 2008.
    The doctor was on his first shift for a GP out-of-hours service.
    Mr Gray's son Stuart, who is also a GP and lives in Kidderminster, said he is pressing for a change in regulations.
    The family has lodged a complaint with the European Court of Human Rights against the German and UK governments over the handling of the criminal inquiry into the death."

  • Comment number 100.

    This may spoon further burocracy....what happens when things go wrong?

    Will this sporn more hours on paperwork less on seeing patients?


    Maybe some budget write off's are better than a whole shift? Generally in government with no competition things go bad quickly!

 

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