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Nadeem Walayat Financial Markets Analysiis and Trend Forecasts

Labour Government to Give NHS Patients Real GP Doctor Choice

Politics / NHS Sep 21, 2009 - 09:13 PM GMT

By: Nadeem_Walayat

Politics

Best Financial Markets Analysis ArticleThe Labour government despite tripling the NHS budget / GP Pay over the past 10 years has resulted in a continuous fall in productivity over the past 6 years or so, has finally announced a proposal to implement a policy that I have long concluded as one of the two key critical reforms necessary to drag the NHS into the 21st century with a view to putting the patient first for the first time since its creation.


Necessary 21st Century NHS Reforms :

a. That Patients should be able to register with any NHS GP regardless of where they live, as analysis consistently suggests there exists a huge discrepancy in the quality of GP services between affluent areas of the country and deprived areas which has contributed to a 20 year gap in life expectancy (UK Swine Flu Pandemic NHS Online Service to Bypass Inept GP Surgeries)

b. That the Money should walk with the patients, as under the current system there exists little if no incentive to put the patient first which is borne out time and time again in analysis, reports and polling amongst NHS frontline staff.

The Government has now proposed to offer real choice to patients to register with ANY GP, regardless of where they live.

GP Choice - Phase 1 - 2008 - The Poly Clinics

The Labour government recognising the disparity in GP services in many areas of the country during 2008 embarked upon a programme of introducing poly clinics or super surgeries in the face of much resistance from GP's which included the British Medical Association (BMA) delivering a petition of more than 1 million signatures to Downing Street against the implementation of 150 ‘Super Surgeries'.

The then Health Minister, Ben Bradshaw lashed out at the scare tactics accusing the BMA of "misleading and mendacious" behaviour in getting patients to sign up to the petition.

"I am not surprised the BMA has collected so many signatures, given the misleading and mendacious nature of its campaign.

"If I were to run a campaign making false claims that something terrible was about to happen, a lot of people would sign my petition too.

"We have received widespread anecdotal evidence of patients feeling pressurised to sign the petition as well as practices telling their patients blatant inaccuracies about local plans." he said.

GP Choice - Phase 2 - 2010 - Register with Any GP Surgery

The Labour government's ANY GP choice announcement is to be implemented during 2010 (after the next general election). On face value this smells of pure electioneering i.e. so as to buy votes from people fed up with an NHS that could not care less of the patients that it purports to serve. Typical experiences (especially in deprived wards) are disinterested GP's that treat patients as ATM cards to swipe in and out of surgeries so as to maximise surgery earnings, where it can take as many more than 5 visits before a patient receives a competent diagnoses, and then has to go through the Hospitals waiting lists where appointments can be arbitrarily cancelled without noticed and the patients made to wait several more months the consequences of which are thousands of unnecessary deaths and minor illnesses which result in permanent loss of quality of life for thousands more annually.

The new initiative will at least start to deal with the estimated 30% or so of incompetent GP doctors that will face real competition and therefore need to either start doing the job they are paid to do or lose ALL of their patients to more competently run GP surgeries. It will also enable private healthcare providers to introduce surgeries in more relevant locations for patients such as near the patients workplace or even within shopping centres or super markets.

Systemic Ms-diagnoses of Patients

Another report in a long line of studies into the lack of GP competence suggests that 15% of GP consultations result in misdiagnoses, where patients with serious illnesses are systemically brushed aside with near worthless shoulder shrug diagnoses, again the answer is to bring market forces to bear onto GP practices so as to ensure that there exists a real incentive for GP's to do a good job rather than go through the motions of performing General Practice which also extends to hospitals and other medical institutions where lack of competition feed the culture of disinterest in performing competent diagnoses.

Daily Telegraph -

Doctors were making mistakes in up to 15 per cent of cases because they were too quick to judge patients’ symptoms, they said, while others were reluctant to ask more senior colleagues for help.

While in most cases the misdiagnosis did not result in the patient suffering serious harm, a sizeable number of the millions of NHS patients were likely to suffer significant health problems as a result, according to figures. It was said that the number of misdiagnoses was “just the tip of the iceberg”, with many people still reluctant to report mistakes by their doctors.

There was a call for better reporting methods to ensure that each misdiagnosis was recorded and monitored properly.

NHS Needs Market Forces

A recent BBC opinion poll on the NHS revealed that 66% of the population fears deadly NHS infections which claims thousands of lives every year because of failure of basic hygiene measures. As many as 1/3rd of people polled would avoid surgery in an NHS hospital for fear of getting an infection. The NHS routinely KILLs tens of thousands unnecessarily every year, with the number estimated for 2009 put at 35,000 with many more thousands disabled.

It may now be lost in the mists of time but there was a missed opportunity during the Thatcher years with regards market orientated reforms of the NHS with a view to putting the patient first, unfortunately of the two remaining objectives for reform during Margaret Thatcher's third term of either reform of the NHS or local government taxation, Margaret Thatcher sought to reform local government taxation by means of the community charge which became to be known as the poll tax and resulted in the downfall of her premiership. Had she chosen reform of the NHS then how things may have turned out differently for both her premiership and for the healthcare of Britain.

It is a fundamental truth of today's NHS that the patient does NOT come first, this was made clear in an opinion poll amongst 156,000 NHS staff that found that patient care is not a top priority for the NHS.

The government having so far only paid lip service to market orientated reforms and that mostly on the supply side rather than demand side. True market reforms have never been an real option as that would in effect put the power in the patients hands rather than the doctors / consultants. The NHS needs to resemble the private market place where the GP or hospital have to compete to attract patients through a record of delivering good competent healthcare. The medical profession in response to such suggestions state that the patient is incapable of making the decision of choosing who is best to treat them. Instead today patients with serious illnesses have to do far, far more than consult a few league tables and GP / hospital reviews to get competent healthcare, routinely patients have to fight tooth and nail to get effective medical treatment that is denied to all but those with the loudest voices and persistence despite their serious illnesses.

Patients are demanding of a more competent and professional health service as the patient is more or less left out of the decision making loop. The key to successful reform of the NHS is to introduce market forces into the NHS, where the money follows the patient right from GP surgeries to hospitals. Thus the healthcare provider is forced to provide competent / good healthcare otherwise the patient will go elsewhere. More so in that GP surgeries / medical institutions reviews and rankings will funnel patients and therefore money towards the better providers of healthcare, and that in essence is the benefit of patient driven market forces. Rather than the present day system where GP surgeries and facilities are maintained whether or not they provide effective healthcare.

The NHS in its present form is a funding black hole with falling productivity that is sucking in ever increasing amounts of cash in real terms. Real reforms are urgently required otherwise Britain will be heading for a health service crisis as the GDP share of health spending continues to expand from 3.5% in 1948 to 8% today to above 11% by 2020, all without any real improvement in patient healthcare.

In conclusion the money MUST walk with the patient to ensure the patient receives competent healthcare. Otherwise the system is maximized to yield the most money for the least amount of work as we have witnessed with the GP contracts.

Therefore a form of health credit card system MUST be implemented where the Patient CHOOSES which hospital or GP surgery to PURCHASE healthcare from regardless of whether it be a government run NHS institution or a privately run hospital, only then will the patient come first and receive the treatment that they deserve rather than the current half way house that costs more and repeatedly fails to deliver the price of which is unnecessary illness and early deaths.

GP Choice Conclusion

It is my opinion that it is the objective of the Labour party to implement a policy of enabling real choice of GP practice for patients, however as the Poly Clinics have demonstrated it is something that if it begins to materialise will be met by much resistance from the GP establishment that are expected to embark up on an even more alarmist campaign of scare mongering than that witnessed during 2008. However the GP doctors also understand that it is highly unlikely that Labour will win the next general election and therefore there is little to be gained by forcefully objecting to the policy ahead of the next General Election.

By Nadeem Walayat
http://www.marketoracle.co.uk

Copyright © 2005-09 Marketoracle.co.uk (Market Oracle Ltd). All rights reserved.

Nadeem Walayat has over 20 years experience of trading derivatives, portfolio management and analysing the financial markets, including one of few who both anticipated and Beat the 1987 Crash. Nadeem's forward looking analysis specialises on the housing market and interest rates. Nadeem is the Editor of The Market Oracle, a FREE Daily Financial Markets Analysis & Forecasting online publication. We present in-depth analysis from over 300 experienced analysts on a range of views of the probable direction of the financial markets. Thus enabling our readers to arrive at an informed opinion on future market direction. http://www.marketoracle.co.uk

Disclaimer: The above is a matter of opinion provided for general information purposes only and is not intended as investment advice. Information and analysis above are derived from sources and utilising methods believed to be reliable, but we cannot accept responsibility for any trading losses you may incur as a result of this analysis. Individuals should consult with their personal financial advisors before engaging in any trading activities.

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