Some important changesto the NHS

Recent steps by the Health Secretary, Andrew Lansley, to establish a 'Cancer Drugs Fund', which bypasses the National Institute for Health and Clinical Excellence (NICE), establishes a mechanism to pay for drugs that some GPs and patients may have wanted, but which may have been viewed by NICE as too expensive for the NHS.

With £50m set aside by central government until March 2011 and up to £200m a year following, some clinicians have already publicly questioned the morality of establishing a fund specifically for cancer, asking 'why cancer?' and not cerebral palsy, multiple sclerosis, muscular dystrophy, epilepsy or one of many, many more chronic conditions.

Clinicians and commentators have voiced further potential complications too.  What happens if one patient is provided with a monoclonal antibody like Avastin and there's no money left to pay for an anti-androgen (to treat prostate cancer) like Casodex?  What happens if someone who needs treatment early in the financial year has funds provided, whereas someone else presenting towards the end of a financial year is denied treatment because the money has already been spent?  It's a moral minefield.

Although NICE may not have been a perfect system for allocating NHS resources, it's drug approval process for funding could easily be viewed as more equitable than a potentially arbitrary decision about the timing of a request for funding, rather than the relative merits of individual drug therapies.

Alongside the changes to funding cancer drugs come other significant changes to the NHS, particularly with to commissioning health services.  The disbanding of strategic health authorities and primary care trusts (PCTs) means that NHS services will be commissioned through new 'GP consortia'.

NHS London has released an intriguing paper outlining the funding of GP Consortia in London, with a payment £1.66 per patient being made available to cover the additional costs of commissioning care.  The paper says consortia will be able to take funding either as cash, or as the equivalent in people, drawing on the exisiting PCT staff.

Additionally, the paper says that where a consortium wishes to draw on PCT staff, they will only be available for one year "as by 2012 they will become subject to nationally required management cost savings, reducing these posts by over fifty percent".

So, given that NHS GPs are having to learn how to commission services with temporary support, as well as being tasked with delivering significant savings to the NHS (through the Quality, Innovation, Productivity and Prevention programme), as well as dealing with introducing a revised way of paying for drugs (Value Based Pricing), it's becoming more and more likely that many NHS GPs are going to have less and less time available for seeing patients.

Less time for seeing patients implies longer waiting times to see an NHS GP (for all but the most urgent cases), which should be a real concern for anyone who relies on NHS GP care.

Sources:

QIPP http://www.dh.gov.uk/en/Healthcare/Qualityandproductivity/index.htm

Value Based Pricing http://www.dh.gov.uk/en/MediaCentre/Factsheets/DH_121652

Cancer Drugs Fund http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_120037

http://www.pulsetoday.co.uk/Journals/Medical/Pulse/2010_November_24/attachments/London%20GP%20consortia%20development%20programme.pdf