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Gordon Brown has promised an array of screening tests designed to shift the focus of the NHS towards prevention rather than cure and to provide more “personal and responsive” services.
In a speech delivered on Monday at the Florence Nightingale School of Nursing and Widwifery at King’s College London, Mr Brown promised “new access to check-ups, screening tests, and preventive health vaccines.”
He said that doctors would become advisers as well as physicians, nurses would become trainers as well as carers, and patients would be not just consumers but partners in their care.
Along with extended opening hours of GPs’ surgeries, tougher action on failing organisations, and greater involvement of patients, these proposals form the backbone of the latest phase of the government’s plans for NHS reform, Mr Brown said.
The screening tests will target abdominal aortic aneurysm in men aged over 65, “a range of heart and circulation problems,” stroke, diabetes, and kidney disease and would use an extended range of diagnostic procedures available in general practices, he said.
A Department of Health spokesman told the BMJ that funding for the new developments had already been set aside as part of the comprehensive spending review. “An announcement on timings and funding will be made next month,” he said.
But he admitted that it was not yet known exactly which screening tests would be carried out, how much they would cost, or how the government proposed to target the most vulnerable and marginalised groups.
“The details have yet to be fleshed out,” he said. “We are looking at who is most at risk and who could be targeted,” to create a “predict and prevent” model of care.
Laurence Buckman, chairman of the BMA’s General Practitioners Committee, said, “Focusing on prevention should certainly be congratulated.
“But, as ever, the practical considerations have not been properly thought through. There has been no attempt to talk to GPs about how these proposals might work.”
Not enough adequately trained staff were available to extend screening, he said, and the knock-on costs for hospitals could be “considerable.”
John Ashton, former regional director of public health for the NHS’s North West region and now director of public health and county medical officer for Cumbria, was scathing.
“We have not had a robust, properly funded public health system since 1974,” he said. “And if you really want to reduce inequalities, you need to target the most disadvantaged.”
GPs had claimed public health as their responsibility, he said, but had only taken it on when given financial incentives.
“The government has now alienated GPs and will finish up having to give them more money to do any of this,” he added.
Liberal Democrat leader Nick Clegg concurred: “This government needs to get NHS money to where it’s most effective, not most politically noisy.”
Andrew Lansley, the Conservative party’s shadow health secretary, said that the proposals “crumbled when you look at the details.”
“There is no proper timetable for delivery. We don’t know where the money’s coming from, but we do know Brown has raided public health budgets,” he said.
See Editorial doi: 10.1136/bmj.39455.385868.80.