Britain gives doctors more power in
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
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