HSJ snap survey: how will the white paper affect you?

Readers' comments (20)

• Anonymous | 12-Jul-2010 8:43 pm

  Manager bashing has never been more in vogue but let us not forget that in this hastily thought through set of proposed reforms, the chaos of organisational reform cannot be underestimated. Nor can the fact that many thousands of hard working NHS managers - who care about the interests of patients and who are as passionaite about ensuring the quality, safety and effectiveness of health services as their clincial colleagues will be rewarded with that committment to the NHS by losing their jobs and being made unemployed...and all in the interest of political expediency and a good headline!

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• Anonymous | 12-Jul-2010 9:35 pm

  Many managers may be hard working and maybe there is a bit of manager bashing as the above reader comments. The fact is that money will be released towards front line staff to see more patients and who better to commission than the doctors who see and treat patients. Managers did not have a clue, just look at the mess we are in......as a patient, I am laughing!

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• Anonymous | 12-Jul-2010 10:17 pm

  Management costs make up a very small proportion of the NHS budget. To make any real savings the NHS will have to reduce services, not a very politically popular thing to do. This whole thing seems to be pushing responsibility away from the government to GP's (essentially private businesses) and this new independant board. When they come to the conclusion that services have to be cut tto avoid going bust the government can claim that it had nothing to do with them!

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• Ginette CAMPS-WALSH | 12-Jul-2010 11:45 pm

  I have just completed this survey and found the questions very subjective/biased. There was no space to voice your opinion if you didn't agree with the statements.
  GPs do not have commissioning experience, but do know what patients want/need and are clinicians.
  Commissioners are not clinicians and do not know what patients want/need or have any interface with them.
  World class commissioning was never achieved.
  Both groups - current commissioners and GPs are not fully aware of treatment options and are not up to date with new medical technologies and less invasive ways to treat patients.
  We do not have enough GPs per capita compared with other EU countries.
  We need quality control on GPs.

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• Anonymous | 12-Jul-2010 11:56 pm

  The naivety of some both amuses me and concerns me.
  
  At a time of financial hardship and the possibility of the NHS loosing its ringfenced status, in combination with the need to find £20 billion, is it right that the NHS faces such structural change?
  
  The target culture from the last ten years is responsible for a marked increase in employment of non-clinicians, and places a considerable workload on those within providers both in terms of data returns but also breach avoidance techniques. It has also improved the NHS beyond all recognition, however, and while I accept the pressure needs to be eased I do not think providers will have the maturity nor the discipline to keep waiting times low. Strangely this could be considered a patient outcome.
  
  PCTs and SHAs have had a clear purpose, perhaps not recognised by all, but actually their strategic level work has not just imposed a level of bureaucracy on the NHS, it has also stimulated service improvement, shared good practice, ensured patient safety, and all for a rather significant 1% of the NHS budget.
  
  I accept PCT commissioning has needed reform, with far greater clinical involvement, but these plans are both progressive and regressive. Progressive in the sense GPs have a greater say, regressive in the sense other healthcare professionals who sit on professional executive committees, and public health departments become less engaged.
  
  Could someone explain to me what is meant by manager? It seems to be used a very loose term; it is generally applied to non-clinicians, who some perceive to be adding little value. In reality there are very few true 'managers' in comparison to private industries.
  
  Personally I don't think GPs are ready for this; some want to lead, others don't, but we can be sure that further reorganisation will add cost to the NHS as each of the 500-600 GP consortia employ supportive functions.
  
  A (soon to be ex) SHA employee, actually working on the frontline making a difference to patients.

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• Anonymous | 13-Jul-2010 7:48 am

  Huge risks are ahead, not all GPs will want to be part of the new arrangements and the level of expertise for GPs has diminished since the loss of GPFH. How will the NHS Commissioning Board manage over 500 GP Consortia - unless additional local arrangements are put into place it will be like herding cats in the fog if not worse.
  
  I expect that most sensible SHA and PCT personnel wil now be leaving, some for NHS Trusts and others seeking early retirement and or the private sector, so their role as keepers of the reforms until their funeral[s] seems to me to be a naive assumption from the SoS and his advisors. The imetable laid out will not, in my opinion, be realised!

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• Anonymous | 13-Jul-2010 8:40 am

  Would someone like to tell me why some £80 billion of taxpayers money is being put into the hands of non-NHS staff (GPs) - who have no allegiance to the NHS and who were the strongest opponents of the formation of the NHS in 1948? These people are some of the highest paid in the NHS and are probably going to get more of our money to encourage them to take on a "commissioning" role that they have no skills for. and that they will have to employ the private sector to manage for them. Privatisation of the NHS has happened!

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• Anonymous | 13-Jul-2010 9:23 am

  I have no problem with the £80 bn being given to non-NHS organisations (GPs), this is money for the provision of healthcare, whoever manages it or provides it.
  
  I am concerned, however, about the backroom staff the new GP consortia will have to employ to commission services effectively. There seems to be an idea that cutting back on PCT staff will provide more money for actual delivery of services; or the provision of cancer drugs for example. I fear that when GPs are placed in the same position as PCTs, the enormity of the issue will be realised - the money available will not provide everything - especially when you have to employ all of those commissioners, accoutnants, etc.
  
  I think my main concern in all of this, however, is education and training. I know of several people in acute trusts who would be able to manage the workforce planning and educatin and training aspects extremely well - but only with the extra money that MPET currently provides. It FTs are left to do this alone, I can forsee the skills shortages returning of the 1990s.
  
  SHAs are an easy target at the moment - but sometimes you only fully appreciate something when it is gone!

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• Stella Welsh | 13-Jul-2010 9:41 am

  GPs are clinically trained individualists who have very limited public health skills. They're accountable only to themselves and their partnerships. Their practice is barely monitored - frankly, there's no point in appraisal if you've so few sanctions for abuse or bad practice.
  
  They live very different lives from most of their patients because of their large incomes. They're not employed by the NHS, neither hired nor fired.
  
  Home visiting is limited to a few subsets of patients. Visits are brief and focused on tasks. Group practices and centralised surgeries mean that few GPs have much real exposure to the living conditions of most of their patients. Patients can't rely on seeing the same GP twice. We're not in Tannochbrae anymore.
  
  Whatever makes them think that GPs are likely to be successful NHS commissioners? It's a wild assumption and a reckless policy.

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• Anonymous | 13-Jul-2010 9:54 am

  So, presumably there will be lots of jobs for consultants to provide the skills that GPs don't currently have in commissioning and management; the leading GPs in these consortia will want more money than their counterparts; backroom functions will have to be serviced etc etc etc.
  
  Meanwhile, we have been struggling for years to provide the information that patients need to make informed choices and this will require more data, more input, more more more......(managers?)
  
  Then, these consortia have to restrict treatment to what is affordable rather than what the newly knowledgeable patient will demand. The govenment can claim its "them not us" and we effectively have a privatised health system. The majority get a limited service and only those who can afford the insurance or to otherwise pay will actually get the choice.
  
  Congratulations, the destruction of the health service achieved in one simple step.

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• Anonymous | 13-Jul-2010 12:20 pm

  Targets may be gone, but outcomes will still have to be reported on - I hope front line staff are ready to do this. Will this improve patient experience? Maybe, because it could improve focus on outcomes. Alternatively, the front line staff may be too busy to spend time with patients.
  
  GPs are going to be a lot, lot busier - I hope they are prepared for this. Or perhaps they will commission former PCT staff or other private companies.
  
  152 PCT become hundreds of GP Consortia: bureaucracy reduced or increased?
  
  A definition of Managers may help. Also, a recognition of support staff (front line clinical and administrators/clerical) would be nice. After all, they will have a significant impact on service user experience.
  
  It would appear that Providers of healthcare are going to have a greater responsibility for education of their staff. I wonder if they will be prepared to pay for it.
  
  Is this privatisation..............or something worse?
  
  
  
  
  
  

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• dennis shaw | 13-Jul-2010 1:15 pm

  i support the G Ps COMMISSIONING PLAN
  BUT THE G Ps MUST HAVE A PUBLIC BOARD OF GOVERNORS AS THE N H S HOSPITAL FOUNDATION TRUSTs HAVE AND THE N H S HEATH SERVICE MUST NOT GO BACK TO THE 1930s
  dennis shaw

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• Anonymous | 13-Jul-2010 2:26 pm

  I am a clinician (not a GP) and note the resentful comments against GP's; presumably from the current commissioning management who stand to be wiped out by all this. The problem with non-clinical managers are they do not understand the clinical issues and are awful at commissioning. We waste so much time explaining to them the clinical issues but still they do not understand. At least the GPs will understand clinical care and then at least do real negotiations and progress patient care. Accountancy, I'm sure will be best left to accountants and yes there will be non-clinical administrative management too, but this time round, it is the GP doctor bosses they will have to answer to.

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• Anonymous | 13-Jul-2010 2:27 pm

  In my opinion, NHS is once again putting public cash in the wrong hands.
  GP’s are clinicians and they should concentrate on treating the patients rather than commissioning.
  They lack the knowledge, expertise and time to get involved in managing the budgets and consortia’s.
  Government has already wasted funds by creating PCT’s, agenda for change, GP contracts to name the few…….
  Once again, coalition government is trying something new out at the cost of NHS jobs and public money.
  I agree managers are earning a lot more than they deserve and there is a lot of consultancy cost.
  Get rid of the managers who are paid obscene amounts and get rid of the agency staff.
  There are people in the NHS who have provided the excellent service without fancy pay cheques.
  The people who will be affected the most are the staff on the lower bands and with greater contribution!
  The higher paid managers will get their redundancy pay and come back as consultants.
  At the higher level, there are more opportunities of networking, hence, better opportunities to do less work and earn more money.
  
  I would say congratulations to Andrew Lansley to single handedly causing the destruction of the NHS.
  

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• Anonymous | 13-Jul-2010 3:08 pm

  I note, rather ironically, in the Job box below is a post for 'Clinical Recovery Manager' £45- 53,000
  I think we will need an army of these posts to deal with the absolute chaos that will result from dismantling the NHS and handing it to GP's and Local authorities.
  As a Clinician of 30 years who 'manages' a whole variety of community services on a pan borough basis, I see little hope of survival for myself, my staff or more importantly my services.
  

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• Anonymous | 13-Jul-2010 3:38 pm

  In response to "I am a clinician (not a GP)" at 2.26pm. What do you understand by the word "Clinician". This does not mean "Medical". It is used to describe anyone working in a clinical environment (providing a clinical service). This includes medics, allied health professionals, healthcare scientists and nurses.
  Many people from these staff groups have moved on to positions in the PCTs and the SHAs, therefore "Clinicians" are already involved - some at very senior level - in commissioning, and understand clinical issues perfectly well. It is condecending to imply that medical practitioners are the only ones who understand the needs of patients.

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• Anonymous | 13-Jul-2010 3:39 pm

  Patients will suffer more than Andrew Lansley realises.
  Pharmacists, Dentists & Gps quibble about the provision of services.
  Politicians sit in their cosy offices not knowing how the professionals behave in the boardroom. A Politician would wipe out years of hard work to create NHS that the world is proud of..........we must not allow that.
  The employment will rise and people will not find the jobs in the current market. There are very many people with lots of experience and are qualified by the experience will not be able to get the jobs.
  

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• Anonymous | 13-Jul-2010 4:39 pm

  There is no hope for coalition government to survive after such a massive blunder.
  We should bring the Labour back.
  It is unacceptable!
  If NHS goes to the dumps, will Andrew Lansley made to resign and expatriated to never land.
  

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• Anonymous | 13-Jul-2010 5:16 pm

  I am finding it quite suprising that a lot of people keep saying that GP's will be asking for the help of x pct staff. I know from my discussions with GP's they think that most are a waste of space. And knowing how tight GPs are they certainly won't be paying consultant fees to them.
  I think you will see the beginning of large GP consortiums as a way of managing commissioning. I also expect the Audit commission to be able to go through their books.
  I do have my concerns with GP's as they are interested in the pound note. However if they are measured on outcomes, they will make sure they meet them to get the money.
  In comparison with PCT commissioners and SHA's who just don't have a clue, I think I'll take the GP's.
  As complaining is going to be a lot easier you just make an appointment with them!

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• Anonymous | 14-Jul-2010 8:34 am

  "However if they are measured on outcomes, they will make sure they meet them to get the money" (above).
  Who is going to measure the outcomes?
  Maybe we should have effective PCTs to monitor this.

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