|Home | About | Journals | Submit | Contact Us | Français|
The health minister Ara Darzi was criticised last week for not having consulted widely enough before publishing his review of the NHS. But his report was welcomed by many commentators for the extra funding that it promised for new technologies.
In his interim report, which was launched earlier than expected, Lord Darzi has promised better access to GPs, a new health innovation council to develop and deploy high technology health care, infection screening for all patients admitted to hospital, and annual infection control inspections in acute trusts.
Lord Darzi insisted that his vision for a world class NHS throughout England would be achieved by giving greater power to local NHS staff and others with an interest in developing health services.
He said, “This is not about imposing more changes from the centre. Effective change needs to be led locally, driven by clinicians and others working in partnership across the service.”
To improve access to GPs Lord Darzi said that 100 new practices would open in areas with the worst provision and that new money would be made available to create 150 new GP run health centres that would be open seven days a week from 8 am to 8 pm. Another plan is for at least half of all new and existing general practices to open their doors on Saturday mornings or one or more evenings each week, the Department of Health announced.
The health innovation council will be chaired by Lord Darzi and will be jointly funded by the health department and the Wellcome Trust to the tune of £100m (€145; $204m) over the next five years.
Although some of the report's proposals will not be developed until the full report is launched next year, to coincide with the 60th anniversary of the NHS, others—such as access to GP services—will be acted on immediately, said the secretary of state for health, Alan Johnson.
The package of changes to improve access to GPs is “a massive investment in primary care provision and will benefit millions of patients across the country,” Mr Johnson said.
However, Iona Heath, a GP in north London and chairwoman of the Royal College of General Practitioners' international committee, said that the proposals were a mismatch between what GPs had negotiated with the government in their contract and what was being planned. “The contract excludes GPs from working outside the hours of 8 30 am to 6 30 pm so I don't see quite how it [the proposed increased access] is supposed to work,” she said.
If the thinking behind longer opening hours was to introduce shifts for GPs then this would destroy the balance between access and continuity, where patients could see the same doctor, said Dr Heath.
Lord Darzi was not the right man for the job of rebuilding morale among primary care doctors, she added. “Rebuilding morale among GPs is supposed to be a clinician led exercise. If they [the government] think that getting a tertiary care doctor to redesign primary care is going to do that then they are barking up the wrong tree,” she said.
Richard Vautrey, deputy chairman of the BMA's General Practitioners Committee, called for doctors' leaders to be included in talks about key issues such as access to GPs and infection control.
“We agree with Lord Darzi that the NHS needs to be patient centred and clinically led,” he said. “The best way to develop a first class NHS is to sit down with patients and representatives of the BMA to decide how to tailor services to meet their needs. We have expressed a willingness to do this on many occasions, and we hope the government will now sit down and discuss their concerns with us.”
Norman Lamb, Liberal Democrats' shadow health secretary, accused the government of “hasty pre-election announcements and fake hospital openings,” adding that “the NHS deserves better.”
“By putting off all decisions on service changes till next year, Labour can safely go into an election without the axe of closures hanging over the ballot box,” he said.
Gill Morgan, chief executive of the NHS Confederation, which represents 95% of NHS organisations, said that NHS staff and the public were being disengaged from the process of reform as they had not been involved sufficiently in discussions about the need for further changes to the health service.
Although she welcomed better access to GPs, Dr Morgan said, “In under-doctored areas, we must make sure that measures to improve services are not simply spent on providing more doctors: we need a whole range of measures to be put in place . . . We must find the missing patients who have not registered with health services and live in some of the most deprived parts of our country.”
The Medical Technology Group, a campaigning coalition of patients' groups, research organisations, and industry, said it was extremely encouraged by the announcement of the new council.
“Technology helps to reduce waiting times and allows patients to become productive members of society more quickly after treatment. But what is so vital is technology's ability to improve patients' quality of life. Giving them freedom, mobility, [and] peace of mind, allowing them to go back to work and contribute to society—we must do all that we can to ensure systems are in place to allow as many patients to benefit as possible,” said the group's spokeswoman, Judy Birch.
However, Niall Dickson, chief executive of the independent think tank the King's Fund, said that “it has not yet been made clear how the creation of yet another central organisation will help.
“Generally we know which innovations work; the challenge has always been getting them adopted. What we need is to create the right incentives locally that will encourage those commissioning and delivering care to adopt best practice as defined by NICE [the National Institute for Health and Clinical Excellence].”
The interim report is available at www.nhs.uk/ournhs.