The Conservative party says it will scrap much of the Whitehall red tape in primary care and hand responsibility to GPs for their own budgets—and for deciding where patients should be sent for treatment.
Speaking this week, the party's leader, David Cameron, said they intended to replace nationally set targets, such as paying GPs based on the number of patients they treat for high blood pressure, with objectives that measure the overall benefit of treatments to the individual patient.
“We won't just concentrate on the money going in but on what comes out as well,” said Mr Cameron. “We want to raise health outcomes to exceed the European average. Outcomes like the survival rate for cancer, strokes, and heart attacks. These are the real measures of good health care.”
He said that national targets, such as reducing waiting times for operations, can distort clinical priorities. He said the Conservatives would “improve the NHS by trusting professionals and devolving power, not through more state control, national targets, and top down interference.”
“We will put GPs in the driving seat by introducing proper commissioning so that the NHS is geared to the needs of patients, rather than the consequence of bureaucratic decision making,” he said.
Mr Cameron reiterated his party's commitment to the NHS. “Over the past year, we have made the NHS our top priority,” he said. “We have explained that we are committed to preserving our NHS and its founding values—a comprehensive universal service, with equitable access, based on need, not ability to pay.”
The Conservatives would improve the NHS for all, rather than encouraging people who could afford to pay to opt out and would have no more reorganisations.
“As part of this we have pledged more independence for the NHS. Later this year we will publish our NHS Independence Bill,” he said, “to take politicians out of the day to day running of the NHS.”
But the Liberal Democrat's health spokesman, Norman Lamb, argued that giving fundholding GPs control of their own budgets, which took place under the previous Conservative government, had caused huge inequalities in the way NHS care was accessed.
“Whether a patient's GP was a fundholder or not determined how fast they were treated—this was unacceptable,” he said.
Meanwhile, Hamish Meldrum, chairman of the BMA's General Practitioners Committee, said he broadly welcomed the move to outcomes rather than targets “provided the outcomes being measured are evidence based and take account of the differing healthcare needs of local populations and individual patients.”
But he was less keen on GPs holding budgets: “It's not just a question of who holds the money but of what other resources are going to be in place to break the present log jam in commissioning health care. GPs have to have their clinical time covered if they are going to give it up to do more administrative work for the NHS locally. You need to look at providing the whole range of resources including adequate data flows about patient treatments, in order to enable family doctors to do the job properly.”
Jonathan Fielden, chairman of the BMA's consultants' committee, said that the BMA had long had concerns with a culture based on targets: “The government's obsession with crude targets has, in many places, distorted clinical priorities and ignored the health outcomes of patients. The Conservative party raises some interesting ideas that deserve consideration.”
Gill Morgan, chief executive of the NHS Confederation, which represents over 90% of NHS organisations, agreed the plans were a step in the right direction: “Both the target culture and the NHS payment system incentivise outputs as opposed to outcomes. So we measure how many hip operations we perform, but not whether the patient actually has better mobility afterwards.
“We need to radically overhaul the way that we measure success in the NHS by putting patient satisfaction and outcomes at the heart of a new approach.”