Names may be new but proposals are not

Senior female woman patient in wheelchair sitting in hospital corridor with African American female

The latest plans allow the NHS and local government to produce 'integrated care systems' - Credit: Getty Images/iStockphoto

When I sat my finals in 1975 the examiners must have run out of questions.

At the end of the oral exam, they asked: “Tell me about the major changes planned for the NHS”. I had no idea but still passed.

Now the Government are planning another change. 

This one, we’re told, will reduce bureaucracy but I do not remember any reorganisation which claimed it would increase bureaucracy.  

Major NHS reorganisations occur with all the predictability of Halley’s comet although far more frequently than every 75 years.  

When I was first in general practice we were overseen by the Executive Committee. This was replaced by the Family Practitioner Committee, then the Family Health Service Authority, then the Primary Care Group which morphed into the Primary Care Trust and finally the Clinical Commissioning Group.

Of course, none of these were ever called by their full name. They were the EC, FPC, FHSA, PCT, PCG and CCG. 

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NHS, National Health Service. Concept with keywords, letters and icons. Colored flat vector illustra

Is the NHS the only large organisation in the world with a combined scrabble score of 61, if we don’t include the letters NHS? - Credit: Getty Images/iStockphoto

One committee was created to look into the problems of teenage pregnancy and sexually transmitted disease. At the first meeting it was suggested that the committee was called the 'Sexual Health Advisory Group' until someone pointed out the acronym.  

As well as the committees overseeing general practice, we also had the Area Health Authority, the District Health Authority, the Regional Health Authority, the District Medical Committee and the Area Medical Committee.

I apologise to any committee I have missed out. Perhaps we could use the list of NHS committees as a memory test. 

Despite all the names and committees there has been one major change which eclipses all the others. In 1989, the Government introduced the 'Internal Market'.

For the first 40 years NHS hospitals were just given a budget. General Practices were paid depending on the number of registered patients with extra money for some running costs. I could refer any patient to anywhere in the country.

The internal market turned general practice into a 'purchaser' and hospitals as 'providers'.

GPs were given a budget to 'buy' care for their patients.

In theory, this meant that hospitals had to show value for money and the GPs could shop around.

This was easier in the cities. Telling a single mum in a flat in Torquay that I could get an excellent deal in Barnstaple was a bit unrealistic.

It also meant that all hospital care had to be costed which itself cost money but at least there was some control over costs and pressure to improve. 

It also took away some of the powers of the Government and made the NHS more independent.

As one colleague commented: “From now on instead to telling unhappy patients to write to their MP they will be told to write to their GP.” 

It is easy to be cynical but organising an effective and fair healthcare system is a challenge for every government throughout the world. In the UK is even harder where the NHS is revered by the British public as much as the Spitfire or David Attenborough.  

The latest plans allow the NHS and local government to produce “integrated care systems'. Health and social care will work closely together and ICS will join all the other acronyms.  

The names may be new, but the proposals are not, at least to Torbay. 

To quote the American Journalist Lincoln Steffens in 1919: “I’ve seen the future and it works”  - although he was referring to the Soviet Union and so may not be a good example.  

In 2005, Torbay Council adult social services combined with the local NHS to form a community trust. This worked well until it fell victim to another NHS reorganisation.  I am sure it will work again.  

Throughout my career I saw the organisation of the NHS like the septic tank in my garden; very important but not very exciting.  

We need a system which will help the frontline clinical and social service staff without too much interference.

This time can the NHS learn from Torbay?