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I'm Gerry Robinson. I have been in business all my life. I have turned | :00:14. | :00:18. | |
around failing companies, and I've managed billion-pound budgets. | :00:18. | :00:22. | |
Three years ago I spent months inside a hospital for a BBC series | :00:22. | :00:28. | |
trying to work out how to make the NHS run more smoothly. Now, as it | :00:28. | :00:38. | |
faces its biggest transformation Since the Government announced the | :00:38. | :00:42. | |
Health and Social Care Bill last year, there's been fear and anger | :00:42. | :00:46. | |
amongst the public about where our Health Service is headed. If you | :00:46. | :00:49. | |
have money driving your decisions, they won't be the best decisions | :00:49. | :00:55. | |
for the patients. The reforms aim to save �20 billion over three | :00:55. | :01:00. | |
years, but are GPs the right people to put in charge? What | :01:00. | :01:06. | |
qualifications do people have to manage something of that scale? | :01:06. | :01:09. | |
What qualifications do you have to... That's an extremely good | :01:09. | :01:12. | |
question and one that I often ask myself in the middle of the night | :01:12. | :01:16. | |
when I'm not sleeping very well. I'll find out where our Health | :01:16. | :01:20. | |
Service is failing... So you think procedures are happening either | :01:20. | :01:25. | |
carelessly or deliberately that don't... Deliberately. That don't | :01:25. | :01:31. | |
need to happen? Correct. I meet the man who is staking his political | :01:31. | :01:35. | |
reputation on these reforms. We've opened the Pandora's box, you know. | :01:35. | :01:38. | |
Every worry about the NHS is now coming in to be part of the | :01:38. | :01:48. | |
:01:48. | :01:50. | ||
question of how do we deal with it I've never seen an organisation | :01:50. | :01:56. | |
like the NHS, as dysfunctional as it is loved. I don't know what | :01:56. | :01:59. | |
these reforms are going to do to the Health Service, so I think it's | :01:59. | :02:03. | |
important that I get out there and meet the people who, you know, when | :02:03. | :02:06. | |
the dust settles are going to have to put these reforms into practise. | :02:06. | :02:10. | |
As the Government's health reforms have generated debate, I have been | :02:10. | :02:15. | |
travelling around the country to form my own view on the Bill. I | :02:15. | :02:19. | |
think these plans have been very poorly communicated. It's - | :02:19. | :02:23. | |
everyone is confused by it, and that confusion is simply not | :02:23. | :02:25. | |
helpful. Despite the Government's listening exercise as the Bill goes | :02:25. | :02:30. | |
back to Parliament, the key aims remain the same, from what I can | :02:30. | :02:34. | |
see - most important is a bigger role for GPs. They'll be at the | :02:35. | :02:37. | |
heart of the new bodies that will replace Primary Care Trusts in | :02:37. | :02:41. | |
making decisions on behalf of us, the patients. | :02:41. | :02:45. | |
And there's one GP who our Prime Minister wants us all to know is | :02:45. | :02:51. | |
right behind the plans. Calm down, dear. Calm down. Calm down. | :02:51. | :02:58. | |
LAUGHTER Listen - calm down and listen to | :02:58. | :03:00. | |
the doctor. Howard Stoate GP a says this, "My discussions with fellow | :03:01. | :03:03. | |
GPs reveal overwhelming enthusiasm for the chance to help shape | :03:03. | :03:06. | |
services for the patients they see daily." | :03:06. | :03:11. | |
Will you tell me how you have been, George? Fine, absolutely fine. I | :03:11. | :03:15. | |
have been having physiotherapy, physiotherapy treatment. Tell me | :03:15. | :03:19. | |
how you found the physiotherapist? Very good indeed. Howard Stoate has | :03:19. | :03:24. | |
been a GP for 29 years and was a Labour MP for 13 of those. Here in | :03:24. | :03:29. | |
the commuter belt of Bexley, the PM's poster boy for the reforms and | :03:29. | :03:39. | |
:03:39. | :03:39. | ||
his fellow GPs have had control over patient care since 2008. | :03:39. | :03:45. | |
morning, Gerry. Welcome to the Albion. How does it work in | :03:45. | :03:50. | |
practise? Instead of GPs saying what services are available to this | :03:50. | :03:54. | |
patient, and say this hospital provides this service that hospital | :03:54. | :03:58. | |
provides that service - that's actually - we think - the wrong way | :03:58. | :04:03. | |
around. If you start with a blank piece of paper, how would you best | :04:03. | :04:06. | |
design a service, not pick a service off a menu of a service | :04:06. | :04:09. | |
that exists, - how would you design a service from scratch that meets | :04:09. | :04:15. | |
the patient's needs, and you start from there. The NHS budget for, | :04:15. | :04:19. | |
butly alone is �350 million a year, and up till now, while GPs here | :04:19. | :04:21. | |
have been making the decisions, the Primary Care Trust has still been | :04:21. | :04:23. | |
signing the cheques. In future, Clinical Commissioning Groups led | :04:23. | :04:25. | |
by GPs like Howard will control the money. | :04:25. | :04:28. | |
I have managed budgets of this size, and I know what it requires. I | :04:28. | :04:33. | |
can't help wondering if GPs are the right people to take control. | :04:33. | :04:38. | |
What qualifications do people have to manage something of that scale? | :04:38. | :04:42. | |
What qualifications do you have to - to... That's an extremely good | :04:42. | :04:45. | |
question, and one I'll ask myself often in the middle of the night | :04:45. | :04:51. | |
when I'm not sleeping very well because it is a great concern to me. | :04:51. | :04:54. | |
What I would say in my defence is that GPs are very good at what GPs | :04:54. | :04:57. | |
do. GPs are very good at understanding patient needs. GPs | :04:57. | :05:00. | |
are very good at talking to their patients to know exactly what their | :05:01. | :05:10. | |
:05:11. | :05:11. | ||
needs are. To prove to me just how well GP commissioning can work, | :05:11. | :05:14. | |
Howard sent me to look at a local cardiology scheme that's won | :05:14. | :05:16. | |
countless awards. It's the brainchild of one of Howard's | :05:16. | :05:18. | |
colleagues who felt his local hospital had him and his heart | :05:18. | :05:20. | |
patients over a barrel. When we tried to get a breakdown of | :05:20. | :05:25. | |
the Bill we used to get for cardiology, it took us 18 months to | :05:25. | :05:29. | |
find out why we're paying the money. GPs should have the power to look | :05:29. | :05:33. | |
at the books and see where every penny of taxpayers' money is going | :05:33. | :05:39. | |
to. Kosta used to refer his heart patients to his local hospital, | :05:39. | :05:41. | |
where consultants usually ordered an angiogram, an expensive, | :05:41. | :05:46. | |
sometimes painful, test where dye is injected into a vein. | :05:46. | :05:52. | |
So Kosta used his new commissioning power to bypass the old system. Now | :05:52. | :05:59. | |
he has a top cardiologist from a London teaching hospital come to | :05:59. | :06:02. | |
Bexley to examine his patients on the spot and decide what tests are | :06:02. | :06:07. | |
needed. It's meant fewer costly angiograms, but that's not the only | :06:07. | :06:10. | |
change. When the consultant sees the patient, he decides whether he | :06:10. | :06:17. | |
needs further investigations, and if he needs angiography, instead of | :06:17. | :06:22. | |
sending them to the hospital, he sends them to Harley Street with | :06:22. | :06:28. | |
the transport provided by the service. Welcome to the weekly | :06:28. | :06:31. | |
heart bus to Harley Street courtesy of Kosta. I caught the bus to meet | :06:31. | :06:35. | |
the specialist who decides who gets on - cardiologist Dr David Brennand | :06:35. | :06:39. | |
Roper. He's convinced the scheme's better for the patients and better | :06:39. | :06:46. | |
for NHS finances. When they analysed the costs of sending a | :06:46. | :06:51. | |
patient to the chest clinic, they found that the average saving | :06:51. | :06:54. | |
versus the average cost of a journey through the hospital | :06:54. | :06:59. | |
including various tests, they saved about �1,000 a patient. | :06:59. | :07:08. | |
So what do the patients make of it? Are you surprised to be going to | :07:08. | :07:12. | |
Harley Street or not on the NHS? It's a nice surprise. I didn't | :07:13. | :07:16. | |
expect that I was going to Harley Street, but yeah, it will be | :07:16. | :07:18. | |
interesting. And there's also bonus for patients like Angela. Unlike | :07:18. | :07:26. | |
the hospital, the Harley Street clinic has a high-tech low- | :07:26. | :07:29. | |
radiation CT scanner which makes invasive angiograms unnecessary. | :07:29. | :07:36. | |
I'm just going to move you into position. The clinic's scanner can | :07:36. | :07:39. | |
scan a heart in a single heartbeat while giving a fifth of the | :07:39. | :07:42. | |
radiation dose of Angela's local hospital version. But it means NHS | :07:42. | :07:46. | |
revenue going out of the system to a private provider simply because | :07:46. | :07:49. | |
they've got better kit. I don't really understand why we | :07:49. | :07:51. | |
can't have similar facilities available within local hospitals | :07:51. | :07:54. | |
within local hospitals within the NHS itself. We spend �100 billion a | :07:54. | :07:59. | |
year on the NHS. A few million here or there is hardly noticeable. | :07:59. | :08:02. | |
Savings could be made in other territories. It seems to me | :08:02. | :08:07. | |
extraordinary that we haven't got more of them because we're still | :08:07. | :08:10. | |
sending patients for these unpleasant angiograms when this it | :08:10. | :08:15. | |
can is available to do it a lot more pleasantly. | :08:15. | :08:21. | |
For the hospitals, it might be worse than just having inferior kit. | :08:21. | :08:26. | |
The way they process heart patients might need examination too. With | :08:26. | :08:29. | |
the transparency that's come with gaining control of patient care, | :08:29. | :08:33. | |
Kosta claims to have found some alarming hospital practise. He | :08:33. | :08:36. | |
believes angiograms were routinely ordered at the local hospital | :08:36. | :08:40. | |
partly because they're a source of income. You know full well that | :08:40. | :08:44. | |
that bill is artificially boosted. So you think procedures are | :08:44. | :08:48. | |
happening either carelessly or deliberately that... Deliberately. | :08:48. | :08:53. | |
That don't need to happen? Correct. Angiograms - they used to do | :08:53. | :08:57. | |
angiograms in your local hospital. And when you look at the figures, | :08:57. | :09:01. | |
500 angiograms of which 180 were actually necessary. The rest was | :09:01. | :09:05. | |
just to create revenue. So when - when we talk about the potential | :09:05. | :09:10. | |
for saving, you think there's a huge potential for saving in the | :09:10. | :09:14. | |
NHS... Billions. Without harming the patient? Yes. The Secretary of | :09:14. | :09:19. | |
State for Health and architect of the new reforms, Andrew Lansley, | :09:19. | :09:23. | |
agrees with Kosta that the current system can encourage this sort of | :09:23. | :09:27. | |
wastage. Well, it can happen, and it happens because of the way the | :09:27. | :09:30. | |
payment system in the NHS works at the moment because it pays for | :09:30. | :09:34. | |
activity so, of course, if you incentivise somebody just to do | :09:34. | :09:37. | |
more work, they'll do more work. What I'm talking about is us | :09:37. | :09:41. | |
getting to the point where what the payment system focuses on is | :09:41. | :09:44. | |
delivering quality and the results for patients, and that's a | :09:44. | :09:49. | |
different matter, of course. Currently, PCTs pay hospitals a set | :09:49. | :09:54. | |
tariff for most of the procedures they carry out, so if hospitals | :09:54. | :09:57. | |
aren't rigorous in weeding out anything unnecessary, the potential | :09:57. | :10:03. | |
for waste is huge. The South London Healthcare Trust | :10:03. | :10:07. | |
told us they refute the allegation that unnecessary angiograms were | :10:07. | :10:14. | |
carried out, and at the time, coronary angiography was an | :10:14. | :10:16. | |
accepted normal investigation for suspected heart disease throughout | :10:16. | :10:20. | |
the UK. The Trust is working closely with local GPs to continue | :10:20. | :10:25. | |
to improve services. Back in Harley Street, it's good | :10:25. | :10:31. | |
news for Angela. Her scan is clear. If this scheme is anything to go by, | :10:31. | :10:36. | |
then clearly GPs are likely to go private if they feel their local | :10:36. | :10:41. | |
NHS services are inefficient. The reforms have been changed so that | :10:41. | :10:44. | |
private providers can't undercut NHS rates, so they'll have to win | :10:44. | :10:48. | |
on quality, not price. That seems pretty straight forward. | :10:48. | :10:54. | |
Yes. But it's still attractive to those like Paul Jenkins who runs | :10:54. | :10:59. | |
the Harley Street Clinic. Does the opening up of the central | :10:59. | :11:04. | |
- or the attempt to open up the NHS - does that represent a business | :11:04. | :11:07. | |
opportunity for you? Yes, I think it does because we have | :11:07. | :11:10. | |
demonstrated with this project with Bexley that the model works, and | :11:10. | :11:16. | |
we're very keen to expand it to other, you know, care trust GPs, | :11:16. | :11:20. | |
commissioners, and in discussions with a number of them. Even Howard | :11:20. | :11:24. | |
Stoate, who is a fan of GP commissioning, has concerns for how | :11:24. | :11:27. | |
local hospitals will fare in the brave new world. What happens if a | :11:27. | :11:37. | |
local hospital can't or won't or is for whatever reason not able to | :11:37. | :11:40. | |
deliver the service the GPs decide to buy, and they are forced to go | :11:41. | :11:46. | |
to other providers because there is no alternative? Now, that's the | :11:46. | :11:50. | |
controversial bit. So will hospitals need to close? And if | :11:50. | :11:57. | |
they do, who makes the decision? What it means is that may be | :11:57. | :12:01. | |
significantly fewer people in hospital beds. There may still be | :12:01. | :12:06. | |
very much, you know, visiting their hospital for the outpatients' | :12:06. | :12:10. | |
appointment visiting their hospital for diagnostics, visiting their | :12:10. | :12:14. | |
hospital as a day case. Now, all of those things means hospitals change, | :12:14. | :12:19. | |
of course it does. It doesn't mean they necessarily close. If it does | :12:19. | :12:23. | |
need those decisions to be made about hospital closures, who will | :12:23. | :12:29. | |
make those decisions? But you don't. You don't in the business world. | :12:29. | :12:33. | |
You don't. You need to decide, you know, how many stores you're going | :12:33. | :12:36. | |
to have on the basis of somebody sitting there with you in - you | :12:36. | :12:44. | |
know, head office with a big map moving things around. You do. You | :12:44. | :12:48. | |
got three Tesco stores within - and one of them is not working. You | :12:48. | :12:53. | |
don't - you certainly don't build another one, and you certainly | :12:53. | :12:56. | |
close one. If the people who are commissioning the service want the | :12:56. | :13:02. | |
service to be there, if the public want the service to be there, if it | :13:02. | :13:06. | |
is transparent that the service is in demand it doesn't make sense to | :13:06. | :13:10. | |
shut it down. But the reality is that not all GPs | :13:10. | :13:15. | |
are happy with what their hospitals are providing, and I feared for | :13:15. | :13:19. | |
some hospitals. For me it was the first sign that GP reform would | :13:19. | :13:21. | |
affect the rest of the NHS especially if no-one is managing | :13:21. | :13:31. | |
:13:31. | :13:34. | ||
from the centre, so how will it affect patients? Like the I -- I | :13:34. | :13:37. | |
travelled from Bexley to hackney East London, one of the country's | :13:37. | :13:42. | |
poorest neighbourhoods and home to Dr Deborah Colvin's practise. If | :13:42. | :13:46. | |
you have money driving your decision, they won't be the best | :13:46. | :13:50. | |
decisions for the patients. If we agree together as a society, OK. | :13:50. | :13:54. | |
These are the outcomes we want. Let's get together and work out how | :13:54. | :13:58. | |
to make them happen, then people will be driven by wanting to do the | :13:58. | :14:02. | |
best for the patient. Like the heart scan project, the GPs here | :14:02. | :14:07. | |
have devised a scheme that joins up a lot of agencies really | :14:07. | :14:10. | |
effectively. It's for patients with diabetes. But unlike the Bexley | :14:10. | :14:15. | |
doctors, in Hackney, they're keeping it all within the NHS. | :14:15. | :14:18. | |
beauty of the scheme is that diabetes is a complex illness, and | :14:18. | :14:22. | |
there are lots of problems, and you need lots of people working | :14:22. | :14:26. | |
together, and if you can bring everybody together, you can work | :14:26. | :14:29. | |
out the best path for them because everybody's different. What works | :14:29. | :14:33. | |
for one person doesn't work for another. Central to the new reforms | :14:33. | :14:38. | |
is patient choice - the mantra is, "No decision about me without me." | :14:38. | :14:42. | |
But for Deborah, the choice between private provider and NHS could | :14:42. | :14:52. | |
:14:52. | :14:55. | ||
If she said I want to see a dietician from this company and a | :14:55. | :15:00. | |
nurse from that company, it would make my life a nightmare. | :15:00. | :15:03. | |
Contacting different people, different payment systems, forms, | :15:03. | :15:05. | |
phone numbers. I would never get everybody together to talk together. | :15:05. | :15:09. | |
If the service wasn't working for me then, I would need to sit down | :15:09. | :15:12. | |
with the people that were working with me and then we could discuss | :15:12. | :15:16. | |
what was going wrong. I wouldn't just necessarily come out and say, | :15:16. | :15:23. | |
well, I need to change this service. In a sense, the informed choice, | :15:23. | :15:31. | |
whether we like it or not, it's true for me, has to be made by the | :15:31. | :15:35. | |
medical expert. I think Debra is really impressive. She's totally | :15:35. | :15:39. | |
committed to doing the right thing for her patients and totally | :15:39. | :15:43. | |
committed to doing it within the health service. She's not happy | :15:43. | :15:47. | |
with outside providers. I've got some sympathy with that. There is a | :15:47. | :15:51. | |
place for outside providers, but it needs to be very, very carefully | :15:51. | :16:00. | |
managed. Private health care providers come from a wide and | :16:00. | :16:05. | |
varied background. Circle are one of them. They run three hospitals | :16:05. | :16:12. | |
already and plan to open another 25. Ail Parsa, a former Goldman Sachs | :16:12. | :16:16. | |
investment banker, is their co- founder. Do you think that these | :16:16. | :16:19. | |
changes will present an opportunity for the private sector to come in | :16:19. | :16:27. | |
and do things, make things happen? Yes, I do. I think that it's health | :16:27. | :16:29. | |
care professionals, social entrepreneurs, they will come up | :16:29. | :16:33. | |
with new ideas, new solutions. Web those ideas and solutions will only | :16:33. | :16:39. | |
work if patients choose to go there. He passionately believes private | :16:39. | :16:45. | |
providers will improve the NHS. years ago we used to spend �37 | :16:45. | :16:53. | |
billion in health care. Today we're spending 127 billion in health care. | :16:53. | :16:57. | |
We tripled the cost of delivery. This country can't afford three | :16:57. | :17:00. | |
times as much in another ten years. We need to look at different | :17:00. | :17:07. | |
solutions. The solution being proposed now is that patients will | :17:07. | :17:11. | |
choose their own treatments from a list of qualified providers, NHS | :17:11. | :17:17. | |
and private. That makes the NHS lift its game. To me, this is a | :17:17. | :17:21. | |
total cop-out. Get the system better with management not with the | :17:21. | :17:25. | |
threat of outside providers. I have absolutely no objection to using | :17:25. | :17:28. | |
outside providers and I've no objection to their making a profit. | :17:28. | :17:34. | |
What I hate is the idea of using outside providers as a way of, you | :17:34. | :17:38. | |
know, making efficiency changes in the health service itself. That's | :17:38. | :17:41. | |
straightforward cowardlyness. If there are savings to be made within | :17:41. | :17:45. | |
the health service, it needs to be managed within the health service, | :17:45. | :17:49. | |
by a central system, which sets out what it wants in a strategic way | :17:49. | :17:52. | |
and follow it's through. It's cowardly. It's wrong. It doesn't | :17:52. | :18:01. | |
actually work. It ends up destroying the organisation itself. | :18:01. | :18:05. | |
I have a strong sense that you're trying to use external competition | :18:05. | :18:09. | |
to make the internal market or the internal service work better. | :18:09. | :18:14. | |
really. My experience of the NHS is actually there is more than | :18:15. | :18:19. | |
sufficient competence, enterprise, innovation in the service. We just | :18:19. | :18:28. | |
have to let it out. Back in May, when the reforms were | :18:28. | :18:34. | |
being debated, the anger out there was incredibly powerful. Do you see | :18:34. | :18:39. | |
this as the beginning of the end of the NHS, do you? I think it's just | :18:39. | :18:45. | |
going to be a brand, a logo, stuck onto a corporate machine, | :18:45. | :18:48. | |
disgusting. These measures affect everyone in our society and the | :18:48. | :18:52. | |
people who are making them and the people who can afford them with | :18:52. | :18:57. | |
private health care, that's fine for them. | :18:57. | :19:04. | |
I think the NHS stands for something quite important. It | :19:04. | :19:11. | |
unites everyone in this country, the NHS. We all have this amazing | :19:11. | :19:17. | |
access to health care. The NHS has been described as the closest the | :19:17. | :19:21. | |
British have to a religion. Many here clearly believe what's | :19:22. | :19:26. | |
proposed is sacrilege. If you're going to change the NHS you need to | :19:26. | :19:30. | |
do it extraordinarily carefully. And the feeling here is that | :19:30. | :19:36. | |
actually this is the beginning of the end. People find change | :19:36. | :19:40. | |
incredibly difficult. Sometimes they have concerns and they want to | :19:40. | :19:44. | |
know those concerns have been heard and responded to. A lot of that was | :19:44. | :19:48. | |
about saying, well, you know, it's going to mean privatisation of the | :19:48. | :19:52. | |
NHS and it won't. But it wasn't about involving the private sector | :19:52. | :19:56. | |
more. It was actually about getting the best possible services for | :19:56. | :20:04. | |
patients. The big driver for these changes is savings. With increased | :20:04. | :20:08. | |
demand and an ageing population, soon the NHS is simply going to | :20:08. | :20:13. | |
cost too much money. Do you know it's horrifying how much money this | :20:13. | :20:17. | |
organisation chews threw and ongoing it's just not sustainable. | :20:17. | :20:22. | |
So it's vital that we make the right changes to make sure that we | :20:22. | :20:29. | |
do have an NHS around over the coming years. It's just crucial. | :20:30. | :20:37. | |
Near the top there. That's it. move this, does it hurt? Andrew | :20:37. | :20:40. | |
Lansley's confident that getting rid of Primary Care Trusts will | :20:40. | :20:46. | |
bring big savings for the NHS. Where the reforms are yet to be | :20:46. | :20:51. | |
agreed, it's already happening. Back in Hackney, Dr Deborah | :20:51. | :20:57. | |
Colvin's local PCT has gone, merged with two others. It's causing chaos. | :20:57. | :21:01. | |
Things are coming apart. We don't know next month where we're going | :21:01. | :21:09. | |
to get our IT support from, because half of it's gone, 50% of the PCT | :21:09. | :21:14. | |
have gone. She took me to her derelict old PCT building. Some of | :21:14. | :21:18. | |
the team were moved from here. But many have been made redundant. | :21:18. | :21:27. | |
Horrible, isn't it? Yes. Those teams don't exist any more and all | :21:27. | :21:31. | |
their memories, all their knowledge of the local area and what patients | :21:31. | :21:36. | |
need and how things work and Who's Who... All gone. All gone. | :21:36. | :21:40. | |
It's estimated that 20,000 redundancies will occur, as PCTs | :21:40. | :21:46. | |
are dissolved at a cost of �1 billion in redundancy payments. | :21:46. | :21:50. | |
I've been involved in any number of changes in large organisations, but | :21:50. | :21:54. | |
this is easily the strangest one that I've ever seen. It's already | :21:54. | :21:58. | |
started. People are being made redundant. Things are changing, but | :21:59. | :22:03. | |
we don't actually know what the end game is. And there's another worry | :22:03. | :22:07. | |
about these reforms, in order to run the commissioning process | :22:07. | :22:12. | |
effectively, GPs are going to have to band together into bigger units. | :22:12. | :22:16. | |
Does that mean we risk losing something special about our GPs? | :22:16. | :22:22. | |
Tuck add way in the Lincolnshire Wolds, I meet Ajay Vora, a country | :22:22. | :22:27. | |
doctor with a thriving practice. Nice to meet you. Welcome to the | :22:27. | :22:32. | |
practice. Thank you. Essentially a single handed practitioner, but | :22:32. | :22:37. | |
we're in a rural area, covering approximately 100 square miles. I | :22:37. | :22:43. | |
work with my wife, who's a nurse practitioner. It's very much a | :22:43. | :22:47. | |
couple-driven practice. We've been here 20 years. We hopefully have | :22:47. | :22:51. | |
got to know our patients very well. I'm excited that I might now, forts | :22:51. | :22:55. | |
first time, have a say in how some of these funds are directly spent. | :22:55. | :23:01. | |
Tell me the patient we're going to see? It's a lady who is house bound | :23:01. | :23:11. | |
:23:11. | :23:12. | ||
now. He took me on a home visit to meet one of his patients. How long | :23:12. | :23:18. | |
is it since you had the fall? when the snow was on the ground. | :23:18. | :23:23. | |
couple of months. When you hear all this stuff about the NHS not | :23:23. | :23:28. | |
working well and all the reforms, what does it make you think? Well, | :23:28. | :23:35. | |
first of all, how fortunate we are to not have the problem. You can | :23:35. | :23:40. | |
hardly believe that they can ring up to make an appointment and being | :23:40. | :23:46. | |
told that we can't see you for a week. When we go to our doctor, we | :23:46. | :23:50. | |
don't get that. Somebody will always see you. It's been nice | :23:50. | :23:58. | |
seeing you Joyce. Yes, I'm pleased to see you. | :23:58. | :24:04. | |
Some independent GPs like Ajay also have concerns. They will be asked | :24:04. | :24:08. | |
to join with local practices to commission as a unit. Where he now | :24:08. | :24:13. | |
has sole control of his budget, he will find himself part of a large | :24:13. | :24:20. | |
group having to make joint decisions. I'm told I have to refer | :24:20. | :24:23. | |
Pat to a certain hospital with a certain consultant because a | :24:23. | :24:27. | |
contract has been put in place that make it's work better, maybe | :24:27. | :24:30. | |
financially. Suddenly now, she doesn't know whether I'm saying | :24:30. | :24:35. | |
that because there's a background motive or because it is the best | :24:35. | :24:41. | |
for her. Now there's doubt put in a patient's mind. I really think he's | :24:41. | :24:46. | |
right. There is a danger that the purity of that patient -GP | :24:46. | :24:51. | |
relationship could be threatened by a financial motive injected into | :24:51. | :24:55. | |
the decision-making process. What really concerned me was who was | :24:55. | :24:59. | |
going to manage and coordinate these GP commissioning groups. I | :24:59. | :25:02. | |
can understand why the power to commission has been centred around | :25:02. | :25:05. | |
GPs. I think it makes a lot of sense, these commissioning groups. | :25:05. | :25:10. | |
But you know, who will hold the commissioning groups responsible? | :25:10. | :25:16. | |
This lack of accountability, which to me, has never been in the NHS, | :25:16. | :25:20. | |
isn't in the NHS and I see nothing in these reforms that will change | :25:20. | :25:27. | |
that. There's got to be a set of people in each part of the country | :25:27. | :25:31. | |
who are responsible. That's for clinical commissioning groups. | :25:31. | :25:35. | |
There is a line, the NHS commissioning board is responsible | :25:35. | :25:38. | |
for allocated resources. They're accountable to the public through | :25:38. | :25:43. | |
the Secretary of State who sets a mandate for the ambitions for the | :25:43. | :25:48. | |
service as a whole. These reforms affect only England. In Scotland, | :25:48. | :25:53. | |
they're moving in the opposite direction. I headed 400 miles north | :25:53. | :25:59. | |
to Glasgow, where they have health boards, instead of PCTs and trusts. | :25:59. | :26:02. | |
Here hospitals and GPs work together much more closely and | :26:02. | :26:11. | |
there is a central report ing structure. Lovely to meet you. | :26:11. | :26:15. | |
Margaret McCartney's practice is in the west of the city. She is | :26:15. | :26:17. | |
genuinely worried for her colleagues across the border. | :26:17. | :26:21. | |
have a sense of impending doom. What's happening in England is | :26:21. | :26:24. | |
horrendous. I do not see any way that patients are going to get a | :26:24. | :26:29. | |
better deal out of this. I think doctors are going to be moved to | :26:29. | :26:32. | |
doing more management, accountancy. Their best interests should be | :26:32. | :26:36. | |
served by the patient in front of them. It's placing doctors in an | :26:36. | :26:39. | |
untenable situation where the patient in front of them is going | :26:39. | :26:43. | |
to be thinking, "Is my doctor deciding not to give me this | :26:43. | :26:46. | |
because there's no evidence for it or because they're not willing to | :26:46. | :26:50. | |
fund it?" On my journey round the country, I've met believers in | :26:50. | :26:54. | |
these reforms and been convinced by them that GPs are probably the best | :26:54. | :26:58. | |
people to handle commissioning. I've also met doubters, deeply | :26:58. | :27:04. | |
worried about the role of private providers and I share their concern. | :27:04. | :27:09. | |
And those who simply aren't sure what the reforms will lead to. I | :27:09. | :27:17. | |
think the stakes here are huge, the very existence of the NHS could de- | :27:17. | :27:20. | |
- depend on getting this right. Who's managing that big picture? | :27:20. | :27:25. | |
For me, that's the question that remains. Unless somebody really | :27:25. | :27:29. | |
does grab this thing at the centre and actually have the courage to | :27:29. | :27:33. | |
make the decision that's are right, but unpopular, I think it could be | :27:33. | :27:38. | |
the end of the NHS. This is my view, but the Health | :27:38. | :27:41. | |
Secretary disagrees, believing the reforms will ensure the NHS is safe | :27:41. | :27:46. | |
in his hands. With a service the size and | :27:46. | :27:49. | |
significance of the National Health Service, you've got to take people | :27:49. | :27:53. | |
with you. You've got 50 million patients who, for whom it's always | :27:53. | :27:56. | |
going to be an important thing. They've got to know that, where | :27:56. | :28:00. | |
they hear noise about is the service going to be fragmented, is | :28:00. | :28:03. | |
it going to be safe in the future? They need to know it's going to be | :28:03. | :28:06. | |
safe. They need to know that the people who work in it are confident | :28:06. | :28:10. | |
it will deliver a better service in the future. I think everyone wants | :28:10. | :28:14. | |
the health service to survive these reforms. If I've taken one thing | :28:14. | :28:18. | |
from my journey, it's that the British love affair with the NHS is | :28:18. | :28:21. | |
alive and strong. I just hope that these changes aren't the end of the | :28:21. | :28:29. | |
affair. Next week on Panorama, remarkable | :28:29. | :28:32. |