Gordon to de-nationalise the NHS?
Dr John Crippen Tue Jun 27, 2006 at 07:20:52 PM GMT 
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Nonetheless, there are rumours floating around the blogosphere or, at any rate, the medical blogosphere, that Gordon Brown is planning an epoch making policy change to be announced shortly after he accedes to the throne.
And that policy change is to turn the NHS into a commissioning agency, buying healthcare in a new independent health care market.
Sounds unlikely, but let us look at the facts.
Over the last two years the mechanisms and bureaucracy that would facilitate such a change have been quietly, dare I say stealthily, slipping in to place.
General Practices throughout England are being bribed encouraged to join together in what are called "clusters". The "clusters" will act as health care purchasers on behalf of their patients. The system is called Practice Based Commission. (PCB)
PCB is a New Labour invention. Well, not really. It is the Thatcherite fundholding system with a change of clothes. A change of clothes that is fooling no one.
Primary Care Trusts (PCTs) are being rationalised and merged. Less management. Less bureaucracy. More centralisation. Oh dear, Dr Crippen feels an Area Health Authority coming on.
The large "super" PCTs will be tasked not with the direct provision of healthcare but with the supervision of the purchase of health care from independent providers.
Radical change indeed. The money following the patient. Hospitals and general practices competing in an open environment to provide a high standard of health care. As one would expect with Gordon Brown, the government will control the purse strings and thus be able to maintain a system of health care for all, still free at the point of entry. The PCTs will make sure that the providers deliver a high quality and economic service.
This will de-politicise health care. It will remove a millstone from the neck not just of the Labour Party but from all political parties.
Stories about this are now appearing not just in the blogosphere but in the main stream media as well. Too many of them for it to be a co-incidence. Someone is orchestrating them. Look at the recent article in the British Medical Journal, reported here : http://nhsblogdoc.blogspot.com/2006/06/who-dares-wins.html
The British Medical Association (BMA), currently in conference, hates the idea. It is seen as a threat to medical independence. Rather than the expensive charade of annual self-monitored assessments (and they are a charade: see Tuesday, 4th April here: http://nhsblogdoc.blogspot.com/2006/04/crippen-diaries-week-14.html) doctors will have to compete to provide quality medical care. Patients will be able to vote with their feet. Doctors who do not perform will be out of a job.
The great and good of the medical profession will fight tooth and nail to block such a change, as traditionally they have fought to block every radical improvement in health care including the inception of the NHS in 1948.
Is Gordon Brown brave enough to do it? Well, soon after taking office he did it with the Bank of England, removing the control of interest rates from politicians.
We shall have to wait and see what happens after his coronation, currently rumoured to be taking place in January 2007.
