IN JULY the Lib-Con Coalition published its plans for reforming the NHS in England. While its proposals for reforming the welfare and benefits system have generated concerns from the HIV sector, there has been little comment, or information, about the ‘White Paper’ dealing with NHS reform, and more importantly, its potential impact on people living with HIV.
Positive Pulse asked Mark Platt, a leading HIV health policy advisor and independent public affairs consultant to unravel the detail and get to the bones of what are being described as the: “The most radical shake-up of the NHS since its inception.”
In simple terms the document, ‘Equity and excellence: Liberating the NHS’, proposes a complete reform of how the NHS in England works. The document contains a number of proposals about reforming and changing the NHS, including allowing non-NHS organisations more opportunities to provide services.
However, the most radical element of the proposals, and the one that has raised the greatest interest and concern, is to hand over a large chunk of the NHS budget - around £80 billion – to new organisations called ‘GP consortia.’
These NEW organisations will be made up of GPs and be required to come together to form a ‘statutory body’, an organisation created by an act of Parliament and given legal responsibilities. These GP consortia, which may also have other health professionals and representatives on them, such as patient groups, will be responsible for commissioning and buying health care services for people living within a defined geographical area.
HIV CLINICS UNAFFECTED FOR NOW, BUT FOR HOW LONG?
Although HIV specific health services are unlikely to be immediately affected, if the proposals are implemented there is likely to be some impact the future.
The white paper proposes that ‘specialist services’, the group which currently includes HIV services, will be overseen by a new independent body called the ‘NHS Commissioning Board’.
However, a little known fact is that the number of people in the UK diagnosed with HIV now takes the condition out of the ‘specialist commissioned’ category. This means that technically it should be a condition that ‘GP consortia’ would be given responsibility for overseeing.
Since this change in numbers is recent, it is highly unlikely that this change in status will have an immediate impact on the commissioning, or provision, of HIV specialist services.
It is also certain that leading HIV organisations will lobby to retain HIV’s categorisation as a ‘specialist commissioned’ condition, and so in the event that nothing happens before, it is most likely that this will be one of the first decisions to be overseen by the ‘NHS Commissioning Board.’
The areas most likely to change are in ‘primary care,’ healthcare provided by GPs and nurses, GP practices, clinics, or health centres. Under the proposals, the bodies that currently manage this part of the NHS, the Primary Care Trusts (PCT) are going to be abolished in 2013, along side the organisations that provide a regional overview for the NHS, the ‘Strategic Health Authorities’ (SHA).
It is this move from the PCTs and SHAs overseeing the NHS to GP Consortia doing the job that is likely to have the biggest impact on everyday care, the care that isn’t provided by specialist HIV clinics. In simple terms, GPs will be both payers and providers, and will have the responsibility for making sure their slice of the NHS budget is spent effectively, and that they don’t overspend.
THE GPs ROLE IN HIV CARE
One area where this might become a problem is with prescription drugs. Over the past few years GPs have been taking much more responsibility for the general care of people living with HIV. Although all HIV medications are provided by HIV clinics, most other medications are now prescribed by GPs.
Heavy users of medications are likely to be of greater concern to GPs than they are now. The question that’s being posed by many health commentators is: How can patients be sure that they’re getting the treatment that they need, and not the treatment that the GP can afford?
The GP consortia will also be responsible for commissioning hospital and clinic care, except where it falls under the definition of specialist care. They will be responsible for making sure that services that they commission, in clinics and hospitals, are good quality, safe, and cost-effective.
The cost-effectiveness of services is going to be vital, because as well as the changes proposed in the white paper, it also commits the NHS to saving £20 billion over the next four years.
POLITICAL GESTURING OR POLITICAL REALITY?
All of this probably sounds very distant, and you may be thinking: What will it mean for me, as someone living with HIV? The simple answer is it’s hard to say, and the fact that the proposals are still being consulted on means that they may not be implemented anyway. Or if they are, the changes that actually happen may be very different from the current proposals.
The more complex answer requires a little bit of background. These proposals are the brainchild of the new Secretary of State for Health, Andrew Lansley. He has been waiting in to implement them for a long time, and is somewhat resistant to them being radically changed.
Although the proposals weren’t universally welcomed at first, the mood of most leading healthcare organisations, including the British Medical Association (BMA) and the Royal College of General Practitioners (RCGP), has changed over the past three months, from: ‘They won’t work’, to: ‘How can we make them work’. So on a balance of probabilities, and failing some major political hiatus, they will probably be implemented roughly in their current form.
The next stage of the process begins when the full consultation closes on 11th October. After that the Department of Health will examine and consider the various responses, and use them to draft a new Health Bill, which is scheduled to be presented to Parliament this autumn.
CHANGE MAY BE A GOOD THING
Many organisations will then seek to have the text amended to favour their own interests, and many MPs will also use the three stage process of passing the bill to try and change it, or even to wreck it, according to their specific party’s perspective, or their own beliefs about the NHS.
Whatever happens in the discussion and debates over the Coalition Government’s proposals over the next few months, it is very likely that healthcare in England will change, as even the Labour leadership candidates have intimated that changes will have to be made to the NHS.
Change may be a good thing for people living with HIV; it could result in better services, in better communication between HIV specialists and GPs, and in more services being provided in non-hospital settings.
However, Kieran Walshe, Professor of Health Policy and Management at Manchester Business School has warned:”large scale NHS reorganisations are huge, and the intended or projected savings from abolishing or downsizing organizations are rarely realised.” Walshe estimates that the proposed NHS reorganisation will cost between £2bn and £3bn.
If the changes result in turmoil and remove money from the NHS, then HIV services, along with many of the other costly ‘long term conditions’ services, may feel the pinch.
The Government’s proposals for the NHS and healthcare in the UK can be found at: www.dh.gov.uk