Health Correspondent Alison Dayani talks to a Birmingham GP tasked with spearheading the Government’s most far-reaching health reforms for 60 years.
Dr Andrew Coward has seen a lot of changes over the past 20 years from his doctor’s chair at Kings Norton Surgery, but he has now been put at the heart of the most radical reforms of the NHS in decades.
Dr Coward chairs a group of GPs which has been picked as one of three “pathfinder GP consortia” in the West Midlands to pilot the plans before the programme is rolled out across the country in 2013.
The reforms will see £80 billion of the health budget handed to groups of GPs, who will have a final say on which services to commission.
Dr Coward’s South Birmingham Integrated Care Commissioning will move ahead with replacing Primary Care Trusts (PCTs) and putting power in the hands of GPs by next year, ahead of the 2013 schedule.
It means he will be the first to experience the benefits from April next year, but also any cracks in the system.
The GP is fresh from a Downing Street briefing with David Cameron and Health Secretary Andrew Lansley when we meet.
“One of its advantages is that it places responsibility with GPs who have their feet in the community,” said Dr Coward. “Public satisfaction rates for family doctors are the highest for any public servant.
“As a pathfinder, we are going early on this to see what works. This isn’t a revolution, it’s an evolution. This is the first time they are making it from the bottom up.”
His enthusiasm is not dampened by concerns that taking on management issues from finances and commissioning services to monitoring local hospitals will draw GPs away from their primary role of treating patients.
“The vast majority of GPs will be seeing patients and won’t be affected,” added Dr Coward.
“There are 26 GP practices in this consortium covering 155,000 patients from Edgbaston to Selly Oak and Longbridge. Only one doctor out of the consortium will have to work half time on the consortium and half at surgery. A couple of others will have some decisions and tasks to do.
“Doctors are not managers and if we try to be, it would be a mistake.
“The NHS got to the point 10 years ago where it was management orientated and we are now getting the right breakdown. Doctors can’t do it on their own and will have the right collaboration with managers.
“An integral part will be to transfer over some staff from South Birmingham PCT to work for us, but there will be some redundancies as the Government is spending £5 billion nationally a year on management and reducing it to £3.7 billion.
“It’s important that we quickly sort out who is being transferred as they are human beings and it will be better for them to know.”
With the background of cuts, the elephant in the room is whether these massive changes can work in the current economic climate.
“Andrew Lansley planned these changes as shadow Health Secretary in the context of an economic boom,” explains Dr Coward.
“If we did nothing and ran the health service as it is, it would be unsustainable. Due to increases in medical technology and people ageing, the cost of the NHS would consume 100 per cent of the gross national product by 2054 according to predictions. The coalition Government has come in during a recession. The NHS has got to save £20 billion over the next three years.
“One could see it as a huge difficulty or an opportunity to create reforms needed to make the health service sustainable.
“There are always risks in life but I can see the opportunities are much bigger than the risks.”
When asked about the whether competition from private firms could strangle the life out of competing NHS hospitals, the doctor dismisses this as a “sideshow” to the real issues.
“Critical to its success will be working together with hospitals, social care and community trusts to design services together,” said the GP. “We won’t want to disentangle anything that is good.
“In terms of funding, our primary aim is to partner with hospitals and deepen that relationship and make sure patients get the highest quality care consistently.”
Dr Coward is confident patients will see many differences once reforms have taken effect.
More services tailored to and in the local area, outpatients appointments done at surgery rather than hospitals, more emphasis on prevention and direct conversations between GPs and consultants to ensure the most necessary and urgent cases are transferred quickly.
But GPs also face making difficult decisions that have made “pen-pushers” at the PCTs unpopular, in particular, whether to fund expensive cancer drugs for individual patients.
Instead of being locked inside ivory towers, doctors will have to deal with being the bearer of bad news in their consultation rooms.
“There will be difficult decisions to make and if we handle them in a reactionary way, we will fall,” adds Dr Coward. “We’ll need to be thoughtful and involve citizens so we have transparency and efficiency to what we do.
“We’ll have a lot more freedom, but with that comes accountability.”
The Health Reforms
* Changes will see all PCTs abolished in 2013 with groups of GPs working together as consortia taking on their roles of managing finances and purchasing services in a bid to drastically cut management costs.
* As GP groups can buy NHS services from the “any willing provider” from NHS hospitals or the private sector, the GMB union claims it will privatise the NHS and “strangle the life” out of NHS trusts trying to compete on price.
* There are three pathfinder consortia in the West Midlands who will spearhead changes in 2012, along with 12 other groups of GP consortia who will follow suit in 2013. Along with South Birmingham’s group, these are Dudley GP Commissioning Consortium, chaired by Dr David Hegarty and Herefordshire GP Commissioning Consortium, chaired by Dr Andy Watts.