In a previous post, I outlined my general concerns and issues with the NHS. It’s clear that most people (myself included!) don’t fully understand how the NHS functions, yet we’re grateful for it’s existence. So, here are a few points on what the coalition government is doing to the NHS, hopefully in plain English:

Bye-bye PCTs, hello GP managers


At the moment when you need some sort of treatment, provision is generally split into two main tiers. Firstly there’s ‘primary care’ which is usually your first port of call when something’s wrong – GPs, and A&E. Then there’s ‘secondary care’ for more specialist treatment, which includes services like hospitals and other specialists such as dieticians and therapists. Unless it’s an obvious emergency, the usual process is you turn up at your GP’s surgery, and if necessary they refer you to some form of secondary care.

Primary Care Trusts (PCTs) largely manage provision of both types of care in your local area. There are 151 across the country, and they control 80% of the NHS’ budget. They work with councils and other bodies to make sure that there is the right balance of services available across an area to match what’s needed by the population.


The Government is abolishing PCTs, and forcing GPs to take on their work. GPs from an area must now club together to form consortia, and do the same work the PCTs did – that is buying, organising and managing health services.

The difficulties is that while GPs know intimately what’s going on with their patients, they are trained to provide general healthcare, not in the art of commissioning services. The likelihood is that either GPs won’t be able to do their actual health work, or they’ll end up paying the same people who do the job in the PCT (or private commissioners that matter) to do the job for them. This may well just end up costing more overall, and a recent parliamentary report suggested that managing and administrating commissioning that already exists accounts for approximately 14% of NHS money.

Also, with the exit of one quango, we have another one the ‘NHS Commissioning Board’, who will tell GPs who they can and must commission from. Needless to say, one of the stipulations will be forcing GPs to spend a proportion of their money on private companies, which isn’t necessarily the best thing for a joined-up health service.

Medical organisations have given the government’s plans a cool response with the RCGP saying:

“Depending on how the reforms are implemented, we must guard against fragmentation and unnecessary duplication within a health service that is run by a wide array of competing public, private and voluntary sector providers, that delivers less choice and fewer services, reduces integration between primary and secondary care and increases bureaucratic costs.”

Meanwhile the BMA has declared it “a massive gamble”, the King’s Fund expressed concern about “the combination of the funding squeeze and the speed and scale of the reforms as currently planned”, and the NHS Confederation broadly support the objectives of the reforms, but point out the risks behind it, and the need to get the public on board.

NHS Sign

NHS Sign by Schtumple

The choice is yours


When you fall ill, you follow the usual routes – e.g. you go to GP, GP refers to you to a specialist at the local hospital – and you get treated end of. In general, your path through the NHS is set out for you and usually based on where you live.


The Government wants to offer people choice of who treats them and how. All good and well in principle, but as Chris Addison points out, people sometimes don’t want choice, they usually just want the experts to know the right answer about what’s best for them. Healthcare shouldn’t really be like picking between cereals in a supermarket..

There are issues of trust and training here, but I for one don’t expect for one moment that my cursory Google search for ‘strange lump’ in any way qualifies me to tell my GP what is and isn’t wrong with me and how to treat it. However some people do and this may result in problems in effectively treating them.

The organisation NICE plays a key part in the NHS – it decides what is and isn’t affordable for the NHS to provide in this country. It’s a horrific job deciding whether adding six months to someone’s life is worth £100k of taxpayers’ money, but as there’s no bottomless pit of money, someone’s gotta do it. This had led to faux-outrage in various tabloid newspapers when Drug X, Y or Z is deemed too expensive to be available here.

The coalition’s plans to neuter the ‘evil’ NICE, and means that pharmaceutical companies are under no pressure to reduce prices, so all sorts of overly-expensive treatments will be bought. Great for those campaigning for and receiving them, but not so great when the money runs out.

The other concern is that if people can pick and choose who their GP is (as the Government is abolishing catchment areas), or which consultant is assigned to them, it could lead to ‘celebrity’ doctors, and massive waiting lists at some ‘popular’ surgeries while others languish with fewer patients.

In the next post, getting rid of targets, ‘any willing provider’ and conclusions. Coming soon.


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