Like asking accountants to practise medicine

The primary job of General Practitioners is to see and treat patients. That is what they spend years at medical school learning. That is what the general public and patients expect them to be expert in and do.

Of all the arguments over the government’s proposed reforms of the NHS, there is one argument that sings out.

General Practitioners are not trained to do commissioning.

That is not to say that some GPs wouldn’t be good at it and some might be keen to give it a go. But it is the case that if management and budgets were the GPs driving joy then you might have expected them to have taken a different career path.

As final year medical student, Tom Riddington, writes on the Guardian website,

The years I’ve spent at medical school have taught me nothing about money. I’m taking one of the few degrees that still guarantees a job and a wage the second I qualify. The only financial management I know is balancing my tuition fees against an ever-increasing overdraft.

But the health secretary, Andrew Lansley, wants me to use £80bn of Treasury money to buy hospital services for patients. I didn’t go to medical school to ration people’s healthcare. It goes against every instinct I have: find the symptoms, make the diagnosis, identify the right treatment – then explain to the patient why I can’t afford to provide it.

As Riddington says, “It is like asking accountants to practise medicine.”

Currently commissioning is done by someone other than the GPs. It is done by the Primary Care Trusts. If PCTs are abolished and the GPs do the commissioning then if GPs are to still see and treat patients, then they will have to ask someone else to commission on their behalf. They will hire private companies or former employees of PCTs.

So the NHS will go through years of upheaval and expense to move from a system where professionals other than the GPs do the commissioning, to a situation where… erm… professionals other than the GPs do the commissioning.

If the government wanted more clinical input into commissioning, there are much easier ways to achieve that.

Best,

Rob

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