There has been much in the press recently about the new role of GPs in commissioning NHS services, and many areas are already forming the shadow health boards that are going to deliver this change. Is it going to improve services or the nation’s health? Sadly I think this is doubtful.
Why? Well, first a quick story. There was once a farmer in Wales who was annoyed by local RAF aircraft. Because his barn was at the end of a long valley, RAF Tornado fighter bombers would use it as a target to practise low level bombing runs. The farmer got sick of the noise and one day went onto the barn roof and painted “!?#$ OFF BIGGLES!” in six foot high letters. The result? More planes! Every type of plane from Chipmink training planes to C130 Transports flew over because they thought it was funny and wanted to see it.
How does this link to GP commissioning? Well GPs are clinically trained to be symptom driven – you go with a condition and, like the farmer, they deal with what is presented to them. Their problem solving does not look at other factors like housing, finances or any of the thousand other things that affect our lives. And nor should they – GPs don’t go through all that training and debt to become social workers.
(It also explains GP attitudes to complementary therapies – if you have spent many years and much cash in becoming a GP, you are not going to be happy when someone comes along and suggests you can achieve the same result by rubbing some lavender on . . .)
But these other factors are so important in looking at the whole person and addressing their well-being. Isolating health from these other factors does not improve overall well-being, it just deals with what the patient presents and ignores the fact that very real progress can be made by looking at the other issues in a person’s life. This is particularly true for older people, because the support an older person needs can be very complex and small interventions can have dramatic effects – for example an increase in welfare benefits brings in more money, which improves diet, which improves health and well-being.
Public health should be about more than just a reactive NHS service, and by putting commissioning in the hands of GPs means that purchasing decisions will still be made on the basis of predicting need rather than funding prevention.
So the move to GP commissioning in the NHS is missing the opportunity to open up the debate on the nation’s health and the relationship between the state and the individual when it comes to that person’s health. I think all GP commissioning is doing is changing the signatories on the NHS cheque book.