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The NHS, maybe one of the last jewels of the British Empire, is ready to retire...?

"The doctor is ready to see you now" has been replaced with "I am ready to see the doctor now".  What are the implications?

Here’s to a healthy 2014 ~ Your NHS needs you.

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 Having passed the retirement milestone of 65 years, you would expect that it would be ready to enjoy many years of peaceful retirement enjoying new pastures and adventures.  However, times are changing, the NHS is a victim of its own success.  It has been too innovative, medicine has moved on.  Couple this with the level of population growth with increased life expectancy and it is obvious that the current NHS is not sustainable.

The NHS may never actually be funded to afford all the treatments necessary in any given year, but successive governments cling to the notion that treatment will remain free at the time of need irrespective of the ability to pay.  This is the fundamental problem.  Our expectations as patients have been cemented into our social and economic DNA.

One of the ways that the NHS can use to cope with these demands is to re-structure and re-brand its products and services.  The most recent reforms commenced in April 2013, when the newly branded NHS England (an innovative name that probably cost a significant budget to implement) took over from the now subsumed strategic health authorities.  Clinical commissioning groups also took over from Primary Care Trusts at a local level.  Included in this reform was the requirement to achieve £20 billion efficiency savings by 2015.  In truth, the easy savings have been made by cutting employment cost and re-structuring the new health organisations and now local health organisations are struggling to find new and innovative ways of delivering services to make further cost savings.

Another factor that has emerged this past year is the need for the NHS to introduce special measures, which ultimately resulted in the breakup of the South London Healthcare Trust.  Effectively this trust was put into administration because it was losing millions of pounds every week.  This case was, however, only the tip of the iceberg and there are many more trusts that have been subsequently identified as being in financial disarray.

In a commercial environment, particularly SME’s, not responding to obvious changes to the market and developing strategies to cope with such demands, will almost certainly result in the demise of the business.  Government will certainly not allow such events to occur to the NHS, but surely it is now time to have the debate about how services are delivered and by whom.  There are many who will argue that the NHS is being privatised, but they fail to acknowledge that the majority of primary care services are carried out by general practitioners, who are themselves independent contractors with the NHS.  Perhaps, when GP earnings become published for the first time later this year, this will add another dimension to the debate.  Their new GP contract will allow flexibility of where patients are able to register.  This may have a direct impact on inner city practices where they will be able to represent a large number of transient working patients.  Will the traditional family doctor service survive?

When the NHS was conceived, it was done so on the back of an ultimatum by the government.  GPs were told to agree to their contract or face the fact that they would be out of work and new surgeries would be opened to compete with them.  Decades later and it seems that no-one is prepared to challenge the need to overhaul how we now provide NHS services.  At one time a patient would attend their surgery to find out what was wrong with them.  They would be visited at home and over time accepted that there was such a thing called a waiting list.  Today, the internet and the availability of information means that patients are better informed and they have been told that the NHS is both free and accessible.  This is an underlying problem.

Perhaps one of the solutions to reduce pressure on the NHS would be the introduction of consultation fees.  A patient would pay a nominal fee to see their doctor and if treatment was required then this would be refunded accordingly.  A radical approach?  Maybe, but these types of discussions do need to take place.

If you were considering setting up a new business, for example a garage, you might consider your location and premises.  What services you will provide and the staff needed to assist in the administration of the business.  Of course, to fix cars you will need mechanics, which you will employ to meet the demands of your workload.  Perhaps, the NHS could learn a few lessons from this type of model.  Is it time for GPs to be employed by the NHS or should they retain their independent status?

The truth is that the NHS is too precious to be treated in this manner, but the debate needs to be had, so at least the honesty of the potential unsustainability of its future can be understood by those that manage and those that use the service.

Patient choice and empowerment has accelerated over recent years and as such, demands are now higher than they have ever been.  The NHS will not retire.  The NHS will need to adapt.  The NHS must understand that times have changed.

“The doctor is ready to see you now” has been replaced with “I am ready to see the doctor now”

The NHS is quietly suffering, but the NHS is not ready to retire.  The NHS will endure, but one thing is clear.  The NHS does need you.

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 Steven Williams