Steve Illife writing on the Health Matters blog poses the question “Liberating the NHS – but from whom or what?” http://www.healthmatters.org.uk/?p=247
Professor Illife identifies three characteristics which distinguish the NHS from health services’ elsewhere:
- freely available at the time of need
- funded largely from central taxation
- built around a gatekeeper model of primary care
He goes on to identify the gatekeeper model based on general practice moderating demand as the focus of the White Paper. Established in 1948 - “in effect a pact between the medical profession and the government, against medical consumerism” – he states that the gatekeeping model is failing in several ways including by large scale inappropriate referrals to hospitals and inadequate community based provision, particularly out of hours.
The crux of the problem is a structural one –
“General practices are busy and there are many problems to solve, so practitioners must prioritise. General practices are for-profit organisations with very limited competition between them for patients. There is little incentive to invest practice resources in solving a clinical problem when specialist services exist to do exactly the same. There is a large incentive to draw the line between generalist and specialist medicine in ways that externalise investment decisions to NHS hospital budgets.”
Illife concludes an excellent overview of general practice including the extent/examples of private sector and not for profit activity, by calling on advocates of the NHS to “acknowledge and solve the gatekeeper problem”.
