Becoming a doctor requires years of study and hard work. It takes five years gaining a medical degree at university followed by in excess of five years to become a GP and more than 10 to become a hospital consultant. None of this extensive training involves business, finance or management. There is no mention of needing an ability to manage budgets or organise accounts on the NHS Careers website. Yet now the Government is expecting doctors to double as business managers. It is handing GPs the responsibility of the vast majority of the National Health Service budget – £80 billion of the total £100 billion. Instead of primary care trusts – which are currently in charge of planning and funding all NHS services in their area and decide what services GPs can offer – the job will be handed to the GPs themselves. The intention is that they will work together in deciding what care to provide, where to buy it – in other words, from which hospital – and negotiating a price.
Every day, GPs come face to face with people who require medical help and are obviously best placed to understand patients’ needs and decide what treatment they should be offered. No one doubts that GPs know better than bureaucrats where the money should be spent. But that doesn’t mean the doctors want the responsibility of negotiating the contracts.
Will it be better for patients? Even if the new system could be strictly regulated to ensure fairness for all – to get rid of the postcode lottery where some PCTs provide treatment and drugs that others don’t – will doctors have the will or the skills to take on this role? It is all too reminiscent of the disastrous GP fundholding back in the 1990s. Thousands of GPs refused to get involved. They wanted to concentrate on patient care instead of turning their practice into a budget-holding business.
The result was a two-tier system of healthcare, with patients of GP fundholders being offered better care and some patients being denied the treatment their neighbours were given because their GP decided to spend his or her budget differently. It also led to a breakdown in doctor-patient relationships, as patients were concerned their GPs were denying them treatment not on clinical but financial grounds. It is true that GP fundholding was voluntary where this new system will be compulsory. So there will be no disadvantaged GP practices without their own budget. But that will not stop patients’ suspicions that they are being offered the cheapest rather than the best treatments in order to save the GP money. And it will not stop one group of GPs deciding to purchase one type of care which another group refuses to fund.
How will GPs’ personal influences and decisions affect patient care? Is it fair if you are overweight, but your GP practice refuses to fund anti-obesity treatment while the practice a few miles away does? Is it fair if one GP practice funds physiotherapy after a stroke, while another doesn’t? And will the new system of giving the money to the GPs directly and making them pay hospitals for treating their patients be any less bureaucratic? Will it result in a cut in the overwhelming red tape and paperwork? Will it reduce the thousands of administrative jobs that the Government intends it to do?
It all seems highly unlikely. There will be hundreds of groups of GP practices compared to 151 primary care trusts. Each will need to employ staff with management and financial skills, probably the same people who lose the same jobs they were doing for PCTs. It is obvious that, if there are more GP groups than primary care trusts, there will need to be more administrative staff.
At the same time, the Government in encouraging hospitals to get rid of non-medical bosses and have senior medical consultants instead of professional managers run departments. Wythenshawe Hospital in Manchester is leading the way with 26 departments being handed over to the charge of consultants who will spend 80 per cent of their time on medical duties and 20 on running departments. The medics will be provided with management training by the local business school.
But medics are not managers. Medics choose their career path because they want to be doctors and treat patients. What a waste of any medic’s time and the thousands spent on training – whether he or she is a GP or a hospital doctor – to spend any part of the day working on the books. There are qualified managers for that role. There is even a specialist NHS graduate management training scheme which trains people interested in business in financial, general and human resources. These are the people best placed to run hospital departments, negotiate GP contracts for patient care, and be responsible for NHS finances. Of course, it costs money to train them – but not as much money as it costs to train a doctor.
You would not ask a manager to carry out a clinical procedure so why ask a doctor to carry out an administrative task? Doctors have the qualifications and experience to make clinical decisions, just as managers have the qualifications and experience to make financial and economic ones. Cardiologist Elliot Hope, a character in the BBC medical drama Holby City, summed the situation up perfectly in a recent episode: “I don’t have a single business bone in my body – I’m a doctor”.
