PFI schemes should be cut first, say doctors
pharmafile | June 11, 2010 | News story | | NHS, NHS funding
The British Medical Association has put forward its own suggestions about how the NHS can save money, and says private finance building projects should be the first to go.
Chairman of the BMA’s GPs Committee Laurence Buckman has outlined a range of areas which should be cut or reviewed in order to save the NHS money.
The new UK government has pledged to maintain a slight growth in NHS spending, while all other departments face painful cutbacks. But the health service must nevertheless find £20 billion in savings over the next four years.
In his speech to an annual BMA conference, Dr Buckman said there were “worrying” times ahead. He said: “Government must be determined to avoid wasteful and ‘un-evidenced’ policies.”
The BMA launched its ‘Look After Our NHS’ campaign in February this year, but this was met with some stern criticism of its own.
Right-of-centre think tank Civitas attacked the campaign as misleading, and said its attempts to shut out the private sector were “misguided and foolhardy”.
It argued that PFI schemes were not wasteful per se, but that they had been badly negotiated by NHS leaders.
In his conference speech the BMA’s Dr Buckman listed a number of areas which could be “consigned to the dustbin of history”:
Wasteful PFI schemes – Private Finance Initiatives now fund over 100 new hospital schemes, valued at £10.9 billion, but they are set to cost the taxpayer £62.6 billion by the time the final payments are made in 2048.
Management Consultants – £308.5 million was the total spent by Strategic Health Authorities, Primary Care Trusts and NHS Trusts on external consultants in 2007/08. In some cases, the NHS is paying external consultants up to £1,000 a day.
Some tiers of NHS management – Many management jobs seem to exist with the sole purpose of supporting successive NHS reorganisations and top-down initiatives of the previous government. Micro-management of GP practices is expensive and unnecessary.
The GP patient survey – Survey results have been consistent since 2006, yet last year alone it cost the government £13 million to run the survey. The view of the BMA’s General Practitioners Committee (GPC) is that detailed and relevant feedback could be more usefully and more economically gathered locally from patient participation groups or local patient surveys.
The bureaucracy of the NHS market – It’s estimated that the ‘internal market’ increased NHS overhead costs from 8% in 1991-92 to 11% in 1995-96 and increased administrative staff by 15% and general and senior managers by 133%. Since 1995 Department of Health statistics show that the number of senior managers has risen by 91%, more than double the 35% increase in the total number of doctors and nurses.
Dr Buckman also listed areas which should be reviewed:
Parts of NHS direct – NHS Direct still refers many of its patients on to GPs or accident and emergency departments and there is little evidence that it relieves pressure on GP or hospital services. While the NHS Direct website is a valuable resource and should be retained, the cost-effectiveness of other parts of NHS Direct should be reviewed.
Choose and Book – Many practices find the e-booking element of Choose and Book useful. However, the “Choose” element is laboriously bureaucratic and requires a lot of expensive NHS staff time, and management. The system is now regularly used by PCTs to ration demand and meet their 18-week waiting times target. In practical terms it is often difficult for patients to exercise real choice.
The current ‘consent to view’ model of the Summary Care Record – the BMA agreed to the current consent model for the duration of the SCR pilots, on the basis that there would be a thorough independent evaluation before it was rolled out further. This is due to be published soon, and the premature roll-out of this scheme is costly and inappropriate.
The building of new Walk-in-Centres and Darzi Clinics – existing centres need to be properly integrated with local services. However, new centres should only be opened after adequate consultation and an assessment of local need has been carried out.
Dr Buckman also warned against “spending money we don’t have” on abolishing practice boundaries would not only be expensive but would “harm the NHS and patient care generally”.
Addressing his fellow general practice doctors, Dr Buckman said: “We, and our hospital colleagues, will all we need to pull together in order to agree, if we can, what can stop without damaging patient care.
“We may have to accept that some parts of patient care may have to change too. Nobody will want that, but if it has to happen, at least let us see how we can minimise the effects on our patients.”
Andrew McConaghie
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