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Friday, 22 August 2008

Changes to NHS Wales

Edwina Hart is certainly a Minister willing to shake-up our NHS.

She's signed the death certificate for the much maligned internal market in NHS Wales – effectively ending the purchaser/provider split.

For our part, BMA Cymru Wales’ has consistently called for an end to the internal market which only serves to undermine the public service ethos and erodes the relationship between professional colleagues, wasting money on bureaucracy that can be put to better use on front line patient services.

Such a move should allow us to take a fresh look at managerial culture, which has distorted clinical priorities to the disadvantage of patients.

The Minister has announced the end of NHS Trusts and LHBs in their current form. These bodies will be reconstituted as one unified body, effectively creating a single local health organisation, responsible for delivering all healthcare services within a geographical area.

In principle, BMA Cymru Wales supports any plan to reduce the number of structures that detract from and absorb resources from the provision of front-line NHS services.

But if the Minister thinks that this is the end of the debate, then some time to pause and think again, would be advised, as there still appears to be some life in the structures argument yet.

For all the political rhetoric – the real work is yet to be done. Far from a done deal many have argued that rather than ending the internal market, NHS Wales could be sleep-walking from the existing internal market between commissioners and providers to a new competitive environment between primary and secondary care, as scarce resources are fought over.

This is causing concern amongst some parts of the medical profession – especially GPs. Understandably, they fear that any new unified bodies, particularly if the intention is to base them at Hospitals trusts, will simply see them continuing to focus on the acute/hospital-based activity. Unsurprisingly, most GPs remain in favour of a model which incorporates a distinct ‘community services’ provider as a counterbalance to the hospital focus that a unified Trust maybe persuaded to take.

GPs fear that the removal of a boundary between primary and secondary care equates to primary and community care being subsumed into a large unified body that will fail to give primary care adequate priority. Worse of all, rather than reverse the flow of resources from primary to secondary care, an Integrated Trust could actually accelerate and exacerbate existing problems.

BMA Cymru Wales will expect from the Minister significantly greater clarity and more detail for the next stage of the consultation process. In our initial response, we made it clear that any ‘integrated’ health body could only be supported if two essential criteria were met.

Firstly, that the new body must be designed as an entirely new entity – rather than one built purely around the NHS Trust model with its present focus on acute/secondary services; and secondly that it works in partnership with GPs, but not interfering with their independent contractor status, which allows them to exercise their patient advocacy role, so valued by patients.

The Minister’s commitment to take the time to do things right is to be welcomed but a ‘can-do’ Minister, perhaps with one eye on the top job – time may not be something that this Minister is willing to waste.