Rethinking the Welfare State: The prospects for ... - e-Library

Rethinking the selfare state 106
information, providers can also take advantage of the system, either by seeking extra
reimbursement on a per case basis or by simply omitting to provide the required service
without being detected. 55
With the insights gained from both its success and failures, the British NHS continues
to evolve. In December of 1997, Tony Blair’s newly elected Labour government released
another White Paper detailing reforms to the NHS that promised to dismantle the internal
market and shift from an emphasis on competition and choice to an emphasis on
cooperation 56 and much more extensive reporting of performance measures by physicians
and hospitals. Medical audits are now the norm across almost all major health
disciplines. 57
The Labour government’s reforms comprise a number of different initiatives but the
most significant is the abolition of GP Fundholders and the creation of “Primary Care
Groups” (PCGs). The latter are to be large groups of general practitioners and community
nurses, which in addition to managing the budgets for primary and community care will
also, eventually, be responsible for purchasing services from the NHS Trusts. On
average, a PCG includes 50 to 60 general practitioners from 20 or so different practices.
PCGs being formed cover populations ranging from 50,000 to 200,000 people but the
average is anticipated to be around 100,000 peopleeach.
Each PCG will have available their population’s share of the available resources for
hospital and community health care services, the budget for prescribing by general
practitioners and nurses, and the budget which reimburses general practitioners for the
cost of their practice staff, premises and computers. The PCGs will not control payments
to general practitioners for the services they provide and general practitioners will retain
their “independent contractor status” under the new reforms.
The difference from the previous system is that people had a choice, even if it were
rarely exercised, to leave one Fundholder for another or for a non-Fundholding general
practitioner. Now, for better or for worse, people have no choice but to rely on their
PCGs to make good decisions. Also of concern is that whereas previously general
practitioners determined themselves whether or not they wanted to be Fundholders, now
general practitioners and community nurses are being forced to assume clinical and
financial responsibility for purchasing a wide range of health care services. The other key
difference between PCGs and Fundholders is that general practitioners who were
Fundholders had a much stronger financial incentive to purchase cost-effective care. With
PCGs any savings made by one general practitioner would have to be shared amongst 50
to 60 general practitioners and, indeed, may be offset by overspending by other members
of the PCG over whom the practitioner has little or no control.
It seems that the Labour government has been less than satisfled with its impact on the
NHS. In its March 2000 budget the government announced an injection of £19.4 billion
into the NHS over the next four years. This expansion of funding likely reflects a mixture
of motives from genuine commitment to the NHS to frustrated impatience with the
failure of New Labour’s policies so far to achieve the hoped-for transformation.
According to the prime minister, the NHS still “needs fundamental reform.” 58