As I said in my blog on July 26th “Liberation through conscription will not work.” Making GPs do something that they don’t want to is and was a recipe for disaster. Since there are some GPs who are , in the current Secretary of State’s words, ’enthusiastic’ about commissioning working with them will move the policy forward. Making those who don’t want to commission was daft then and is daft now.
So if there ever was going to be a plan B for the Government’s NHS Reforms it would be to remove the strange yearning that the Government has for conscripting GPs into their own liberation by using the force of the law to make them commission.
On 30 March the Evening Standard had a small paragraph stating that it had emerged that ‘flagship proposals on NHS reform were to be watered down’. It went on to say that “Plans to abolish PCTs in 2013 could be ditched in favour of introducing new GP run services more gradually”.
Now who knows whether this is true, but the Evening Standard is the place that Government Departments choose to leak something in the afternoon that they don’t want to put in the national media. The Standard always used to call itself the paper that is read by more MPs than any other, simply because it is picked up and read in Parliament most evenings. If I wanted to give a message to a Tory MP short of writing them all a letter, leaking a paragraph to the Standard is how I would do it.
If the Government was ever going to have a plan B this is what it would look like. Encourage enthusiastic GPs to get on with it and withdraw the clause from the Bill that abolishes PCTs.
As a policy last July such an approach would have ensured that the Government were not carrying out a top down reorganisation. It would have gone with the grain of what GPs wanted across the country, and whilst there would have been a bit of a row, it would have limited the necessity for national legislation to make the entire system do the same thing at the same time on the same date.
If that would have been a sensible policy then surely 9 months later plan B would still be a sensible policy? Things can’t change that quickly from good to bad can they?
Er… yes they have.
Whilst a politician may be very relieved to hear, in the middle of this week in Whitehall, that there will be a PCT safety net to carry out commissioning in those areas where their GPs do not want to do this , by the time they get back to their constituency this Friday, that PCT will have disappeared.
This change of policy is what used to be called a “post noose reprieve”. (When we had capital punishment in this country very occasionally people would have their sentence reprieved, but sometimes this was after it was carried out. So the person may have the satisfaction of being labelled innocent, but they had already been hung).
PCTs may be about to get a post noose reprieve.
The timing is a real problem. If in the next few days the Government were to announce this change of policy, they will be reprieving PCTs very close to the date of April 1st when they are being abolished.
So irrespective of what Parliament wants, on this Friday PCTs are being abolished and clusters of PCTs are being created. On 11 February I posted that PCTs were being abolished and clusters were being formed. Since then Chief Executive of PCTs have been applying for these cluster jobs and most have been appointed to start on Friday.
The post of PCT CEO as an accountable officer has been abolished.
So if you are in an area where GP commissioning does not take place as of Friday there is no PCT to continue carrying out commissioning.
Over the last month the safety net has been ripped up.
On 17 January I posted a blog quoting the Prime Minister as saying how important it was carry out reform at a quicker speed than Tony Blair. He is to be congratulated in implementing his policy of abolishing PCTs before Parliament has agreed to it.
If you like that sort of thing, it’s admirable speed.
That now means that his plan B of allowing PCTs to continue beyond April 2013 where they are needed is impossible.
In the next few days we will have the very odd site of the Government trying to resuscitate PCTs on almost the exact date that they have killed them.
I am not sure if this Government ‘does irony’ but someone, somewhere should get a chuckle out of this.