Thursday, 17 January 2008

The Britnell Privatisation Challenge - coming from a PCT near you

The NHS is closer resembling the Soviet system of the 1960s as each day passes, and one man who is rather involved in giving Stalin-like orders from the top is a chap called Mark Britnell, his unpleasant bullying has been noted in blogosphere before.

The ferret fancier has got hold of leaked PCT documents which show that the government, in the form of the Department of Health's Britnell, are ordering PCTs to start opening a swathe of privately run Walk in Centres up and down the country. Importantly this is being done in the most top down antidemocratic manner possible, as this has been done without consulting the public adequately, without consulting the medical profession and is to be done even in areas where there is no problem with accessing GP services.

This sick twisted ideological reform is called the 'Britnell challenge' by PCT monkeys in the know. Darzi's review is being used to back this agenda up, even though the sham consultation process has not yet been completed. In Oxfordshire there is hardly a problem with access, as you can see:

"•National GP Patient Survey 2006/07

•In Oxfordshire responses of 46% to the access survey were received compared to 47% average for NHS South Central PCTs and 44% nationally
•In Oxfordshire 94% of people reported that they were satisfied with their ability to get through to their doctor’s surgery on the phone compared with 86% nationally
•In Oxfordshire 90% of people who tried to get a quick appointment with a GP said they were able to do so within 48 hours compared with 86% nationally.
•In Oxfordshire 88% of people who wanted to book ahead for an appointment with a doctor reported that they were able to do so compared with 75% nationally
•In Oxfordshire 92% of people who wanted an appointment with a particular doctor at their GP surgery thought they could do this compared with 88% nationally
•In Oxfordshire 84% of people said they were satisfied with the current opening hours in their practice, the same as the national average "

While the educated local opinion realises that this top down enforced reform is not a sensible use of NHS funds:

"Everyone locally seems to agree strongly that it is both damaging to the local NHS and a waste of resources - but the managers feel unable to resist DH central instructions to introduce competition in order to make us extend opening hours."

The privatisation will be done using the Alternative Provider Medical Services route (APMS), a contractual route through which PCTs can contract with a wide range of providers to deliver primary medical services that are tailored to local needs. The PCT run procurement of these APMS contracts has not always been that transparent or competitive, I can't imagine that this will change. The PCT's documents show clearly that there is no choice in this reform agenda, they must obey Britnell or else:

"•During 2008/09, all PCTs will complete procurements for new GP-led health centres providing convenient access to GP services"

The DoH are not as clueless as the PCTs, but they are far more cynical and corrupt. It is just such a waste of money to be forcing ideological reform upon the public in this blanket and short sighted way. Oxfordshire is a great example of how just stupid the DoH are. Patients are remarkably happy with their GP services here and there is simply no need for this costly reform, but the PCT have to follow orders from Britnell and his boys. I thought this quote taken from the end of the PCT's slide show summed up just how dumb this all is. The blind are truly leading the blind here, the head of the PCT's commissioning presented the questions below as the final slide of his sermon; really someone who is in the process of changing the way primary care is run in his region should have some idea of the answers?

"•What would ‘best’ look like?
•Who do we need to work with in developing Primary Care Strategy?
•How would we know we have got ‘best’ services? "
Aneurin Bevan would not be turning in his grave, he would be locking and loading his double barrelled shotgun and making his way rapidly towards the DoH's headquarters.


jayann said...

This is only actually nefarious if the contracts are unfairly awarded to a 'private' organization as opposed to, yes, private, i.e. self-employed, GPs. And it could be beneficial if it replaces one-partner run-down practices of the kind you must have come across (the kind whose existence made me begin to check practices out before registering, by asking, yes, the right kind of middle class female patient).
I do though understand your concern.

(Garth, where are the Rants? I hope it's simply that their server's acting up.)

Garth Marenghi said...

I agree, there may be a case some extra practices in some areas, but I am not a fan of the WIC format.

The one size fits all is silly.

The problem is the tenedering process is invariably conducted by PCT numpties who cannot make a proper informed decision:

for example,§ioncode=23

Garth Marenghi said...

It must be a server thing, I can't even upload the main page at the moment?

jayann said...

The problem is the tenedering process is invariably conducted by PCT numpties

well yes -- thanks for your reply, Garth.

(I hope it's just a server thing, I can't upload the main page either and haven't been able to for about a day now. I suppose if there were a real problem we'd be getting a 404.)

Aubrey Blumsohn said...

The Soviet link is quite appropriate - with each step we are slipping more and more into a Soviet (i.e fascist) state - from ID cards, to enforced uploading of medical records, to micro-control of everything from detailed employment pathways, to clinical practice "guidelines", to completely non-transparent drug regulation, secrecy, spying, the gradual blurring of lines between industry and the state, state control of professional bodies.... Why expect health systems to be any different? said...

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