There are 2 very important changes that signal the end of the NHS.
The first is the free for all for Commissioning consortia. Historically PCTs have covered a geographical area and have been responsible for care of all the people in that area. PCTs are to be replaced with commissioning consortia. The Royal College of General Practitioners, based on international studies of similar organisations said that they should have a minimum of 300 000 patients in order to have a sufficient economy of scale to effectively commission the range of services their patient’s need. Many doctors warned that they should be co-terminous with local authorities and responsible for a geographically defined area. The government have allowed anyone to set up a consortia. There is a list of consortia here. In london they range from 7 to 67 practices in size. They are not obliged to cover a geographic area.This allows GPs to select the most efficient practices and avoid the least efficient.
The second important change is the loss of GP boundaries, now set for April 2012. Spun as patient choice, this may allow GPs to choose patients. Patients who are housebound or have long-term serious illness are much less likely or able to choose a practice that is not very close to them. The patients who will be looking for a practice away from home will be the young, fit and mobile. Business minded practices will be looking to register these patients because they earn money for registering them, but they do not incur costs caring for them. By contrast, a very sick patient incurs a lot of costs because of time for home visits, prescription costs, nursing time, hospital admissions and so on. I have written about practice boundaries here.
The combination of selecting practices and patients and the abandonment of the duty to provide care for a defined area is a MASSIVE change in how the NHS works. In the very near future, patients will register with a consortium to be entitled to the services the consortium provide and have commissioned.
This sets in place perfectly the structure for commissioning consortia to form Health Management Organisations (HMOs), the US insurance companies that select patients and set fees according to risk. Yesterday Mike Birtwistle blogged about the underlying conservative committment to converting the NHS to this system,
Many on the Conservative right believe that any reforms which do not lead to a move towards insurance-based healthcare should be decried for their timidity. You only need to read a Reform report on health to realise that this strand of thinking is alive and well and very attractive to certain sections of the Party.
Colin Leys and Stuart Player warned about it in their book, The Plot Against the NHS.
Update 27.01.2012 CCGs further widen health inequalities
How many more warnings do we need?