So the new NHS vision has been released. GPs will be responsible for a huge amount of money, deciding in which services to invest, what services to buy from local providers, how to create maximum competition between other NHS providers and the private sector. Over 150 Primary Care Trusts will go, as will ten Strategic Health Authorities along with the legions of ineffective middle management that staff these organisations.
All this is to be largely applauded. Whilst allowing GPs so much freedom with so much money is inevitably a risk it is a better system than the current one - as long as the same people who run things now are not reemployed by GPs to do the same in a different setting.
But the government has missed a large and important trick. Secondary Care should also be commissioning services. GPs do not, and cannot be expected to understand the requirements of each and every disease state - especially those with chronic disease. It is hospital specialists who are best placed to advise on the intricacies of the needs of patients in these groups, not GPs. Furthermore, giving all the purchasing powers to Primary Care reinforces the sad message of the internal market that GPs are little more than conduits for channelling patients towards those who can actually treat them; little more than a shop front for the 'real' medicine that lies further into the service. This is of course not the case as GPs have a vast array of services that the provide and herein lies a further problem: is there not a massive conflict of interest here with publicly funded businesses paying themselves for as much as they like?
So, the report so far? Nothing wrong, Mr Lansley, but only half right.