The core at the heart of Coalition Government's NHS reforms is to scrap ALL NHS Primary Care Trusts (PCT's) to be replaced by competing GP Consortia's to directly manage patient treatment commissioning (the process could take 2-3 years to implement).

However whilst the media has been focused on the news of scrapping of all NHS PCT's, the flip side of the coin lies in the consolidation of GP practices into GP consortia's that is aimed at attempting to introduce real competition between GP surgeries for patients with the result that the under performing GP surgeries in cities such as Sheffield could disappear as they are unable to compete for patients in a more market orientated value for money environment due to their inability to provide health services to the satisfaction of a large % of their patients (as evidenced by the UK GP Patient Survey), thereby patients and resources are reallocated by market forces to the better performing GP surgeries, and therefore both patient healthcare improves and costs are cut.

The anticipated changes are set against the current system which contrary to what the population believes GP's are Independant PRIVATE contractors to the NHS that operates as an old boys network WITHOUT COMPETITION.

Unfortunately whilst the aim was for better value for money by means of competing consortia's, the implementation is proving to be resulting in the exact opposite anti-competitive consortia's, as virtually all of the Sheffield NHS 92 GP Practices have signed up with one of of 4 geographically located GP Consortia's in advance of the implementation of the Coalition Governments NHS reforms.

• Central Sheffield Consortium
• HASC ( Hallam & South Consortium)
• North Sheffield Consortium for Health
• Sheffield West Consortium

The flaw in the construct of the consortia's is that there is nothing to suggest that the consortia's and GP surgeries will be competing for patients which therefore means the governments planned reforms will fail and patients could end up with an even worse health services as GP surgeries will be wielding greater power within their geographic constructed Consortia's then they were able to wield under the city wide Primary Care Trust, therefore no competition in GP services will exist and the governments reforms are destined to fail, just as badly as Labours 2002-2003 GP contracts failed as they sent annual GP pay rises soaring into the stratosphere, culminating in pay rises of more than 30% per annum which effectively means that GP's are now paid nearly twice that of where there pay should be at in terms of average earnings.

The Explosion in GP Pay contributed towards the MP Expenses scandal as when Labour came to power in 1997 average MP pay was £43,722 against average NHS GP pay of £44,000, so both were inline with one another at that time. However as the below graph illustrates in 2003 GP and MP pay started to see a serious divergence which ignited jealousy amongst MP's that directly led to the adoption of the policy of claiming expenses to the maximum so as to fill the ever widening gap between MP's and NHS GP's, as MP's could NOT get away with awarding themselves pay hikes of 30% per annum without voter out cry and risked losing their seats at the following general election, therefore across the board systematic abuse of expenses started to take place which basically meant real average MP pay was approx £98,000 per annum, still considerably less than where GP pay had risen to.

Whilst spending soared on the NHS, productivity fell by an average of 1% per year, as illustrated by a Labour government commissioned report (McKinsey) during 2009 that called for a 10% cut in the NHS workforce which was buried ahead of the 2010 general election and only recently been published by the new coalition government.

NHS GP's are clearly hoping to replicate Labours 2002-2003 GP contracts incompetenance by seeking to double their pay yet again under Conservative Consortia reforms incompetance. Therefore for the Coalition Governments reforms not to fail in Sheffield and elsewhere, Sheffield's four GP consortia's should be disbanded in favour of the creation of city wide consortia's that will enable patients to easily switch between the better and poorer performing Consortia's as the current system ensures that Sheffield's NHS GP Post Code lottery will just be magnified due to lack of sharing of best practice which will become more concentrated in the better performing GP surgeries as the below post code lottery map illustrates (Sheffield NHS GP Post Code Lottery Map, The Best and Worst Ranked Surgeries )

Without real competition for patients between GP surgeries then patients in deprived areas of the city will further suffer that will result in a widening of the already large gap in life expectancy of 14 years between affluent and deprived areas of the city.

Hopefully the Coalition government will recognise this flaw and implement measures that ensure anti-competitive Consortia's are forced to be disbanded in favour of competing GP Consortia's.

NHS Sheffield (http://www.nhssheffield.com), is a completely Independant information and Sheffield NHS service delivery monitoring site, where patients will be able to share information and experiences on actual receipt of health services as opposed to NHS self generated information and data that Independant reports regularly imply amount to nothing more than propaganda that does not match actual patient experience.

By Nadeem Walayat

http://www.walayatfamily.com

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