…for the Secretary of State it’s, can he claim that his policies have made this happen?
Last week the HSJ revealed an analysis of figures that showed that the recent national downward trend of GP referrals had returned to its historical upward trajectory. In fact the current peak of referrals from GPs is now higher than its previous highest point. This is bad news for the NHS since it shows that current attempts at managing the demand for secondary care do not appear to be working. .
This is probably the key issue for the future of a sustainable NHS. We know that there will be an annual increase in the need for health care over the next decade caused by the increase in the number of older members of society being sicker. Unless this new demand for health care is dealt with through achieving much better value for money than the existing models of care, the NHS will not have the resource to meet the demand.
To thrive the NHS will need to create a model of health care which creates significantly better health outcomes for patients using the same level of resource it does at the moment. This will require changes to the whole system but it also needs to heavily involve change with GPs and their referral behaviour.
Apparently Andrew Lansley had been claiming that the recent fall in GP referrals was the result of his policy of GP-led commissioning. It is of course understandable that he is desperate to find some good news from his reforms.
But this claim, in early 2012, must be a ‘busted flush’. Intellectually he knows that his reformed system is not yet in place. In fact there are no CCGs that are legally authorised to achieve anything. Even though he badly needs some good news to show that his reforms had some rationale (since he gave us no reasons whilst the Bill was being passed) it’s just not possible to claim any national outcomes from a system that is not yet in operation nationally.
I am sure that with the very best CCGs there will have been an impact on overall demand. But the problem for the Secretary of State is that he has chosen to develop a process that he claims will reform the national programme. One of his many mistakes was to launch into this national programme before he had found out whether there were sufficient GPs with the interest and the capacity to develop the real commissioning drive to cover every practice in the country.
As many have suggested he could have carried out all of these reforms at a slower and more secure pace. He could have developed and demonstrated models of peer-to-peer relationships clearly reducing GP referrals. These could have taken place in locations where there was active GP commitment and capability to transform commissioning.
The Secretary of State clearly decided against this.
But in fact even though he thinks he is creating a new national system from 1 April 2013, he won’t. If all goes really well, and with a really favourable following wind, a third of the country will have GPs that are actively involved in transformative commissioning. The others will be playing the same catch up that they would have been if the Secretary of State had instituted this in a phased way.
Whatever laws he may pass reform depends upon the active commitment of real people.
What the Secretary of State is discoveri9ng is that laws are very good at stopping people from doing things. But they are very bad at making people do things when they don’t much want to do them.