The Wardman Wire

I picked up a consultation document about a “New GP-Lead Healthcare Centre” for Notinghamshire yesterday. The consultation period finishes today.

I’m not going to beat them up about not seeing the document earlier, as my GP and my address are just (half a mile) in Derbyshire. The NHS in each county are getting much more territorial though - I’ve been forced to stop using an optician in Nottinghamshire for my diabetic eye checks (where I went several years ago) because Derbyshire compel me to use their self-delivered service - at the cost to me of an extra half-day off work every year.

However, I am going to have a go at the logic and quality of the programme and the consultation.

I have uploaded the whole document here.

(Note: Polyclinics and GP-Led Health Centres are not actually that different).

Summary

This document is about a new Health Centre: “the policy to establish at least one GP-led health centre in each PCT in the country has been set by Government”. The process is a “consultation” about “which services should be delivered by the new GP-led Health Centre” and “where should it go” to “reduce health inequalities”.

It seems to me that a real consultation process should be investigating whether health inequalities are best reduced by delivering services via GP surgeries or something more centralised. This consultation process doesn’t. Instead it is bound by:

We are required by the Government to establish a new GP-led health centre

As I see it, the key problems with this are:

1. Health Inequality is a very fine-grained problem. Coarse grained solutions are not the best way to deal with it.
2. It should be a matter for local decision. This solution - as clearly as the nose on the elephant’s face that is sitting in the corner of the room - has been imposed centrally.

I even caught Alan Johnson MP (Health Minister) on Radio 4 this morning, talking about how access to local services will be improved and inequality reduced by putting one big new centre at one place in each Primary Care Trust. You couldn’t make it up.

You heard it from the horse’s mouth. He even managed to get “subsidiarity” into a sentence about doing things centrally that can arguably be done locally.

*** Head. Desk. Thud. ***

The Gory Detail is below the fold.

New Healthcare Centre for Nottinghamshire

A few snippets from the document linked above.

We are Nottinghamshire County Teaching Primary Care Trust (PCT).

Check. You supply GP services for Notts.

The PCT is the local NHS organisation responsible for planning and paying for General Practice services across the county to ensure that accessible, high quality primary care services are delivered to all registered patients. Our geographical area covers the local authority areas of Ashfield, Broxtowe, Gedling, Mansfield, Newark and Sherwood, and Rushcliffe.

Check. Those are indeed the areas.

One of our key responsibilities is to improve and protect the health of the local population by tackling health inequalities such as reducing smoking, which is the major cause of cancer.

Check. Reduce inequalities across the board. That would be why - for example - you are arranging two new GPs for Kirkby-in-Ashfield because it is underprovided (sorry - couldn’t find the link). Good.

Though I struggle to see “reducing smoking” as a “health inequality” on the first page of your document. Surely “health inequality” is a noun and an objectively measured set of data , and “reducing smoking” is a programme to meet a “health inequality” if you have found one? Finger trouble on page one of a major consultation document? Hmmmm.

What are we looking for?

One of our key priorities is planning – working out what the health needs of local people are and how best services should be provided. The PCT is committed to improving people’s health across the County, particularly in the less well off areas.

Check. You want to consult us to help you work out what our needs are and how services should be provided. Good.

We want to set up a new GP-led health centre in the County. It needs to be placed in the part of the County that will bring the most benefits to the local population.

What? You just said (previous para no less) that you wanted to ask US how services should be provided.

“We want to set up” is not a question. It is a statement of what you are going to do. How can we help you plan when you have already made the most important decision.

This document sets out our proposals and seeks your views on what services should be offered and where it might be placed.

And what if I want to be consulted about whether we actually want this type of centralised GP-led Health Centre?

Why do we want a new GP-led health centre?

The policy to establish at least one GP-led health centre in each PCT in the country has been set by Government so part of this consultation is on services the centre will provide and its location.

“The policy has been set by Government“. So much for consultation.

We are going to advertise for anyone interested in establishing the new health centre and we will be looking to award the contracts by the end of December 2008. The new centre should then open by April 2009.

“We are going to“. So much for consultation.

Summary Estimated Population Table of Data.

1 Newark & Sherwood
2 Rushcliffe
3 Ashfield
4 Mansfield
5 Gedling
6 Broxtowe

Yep. Six areas of the county. Fair enough.

How did we work out where a new GP-led health centre should go?

You should start off by asking us the right question. Do we want a GP-led health centre or not? The fact is that you are proposing putting a major investment into one area out of six, which cuts directly across your declared aim to seek to improve services across the County. The effect is likely to me to increase inequalities, not reduce them.

Investment should be spread more equally. Over the last 10 years there has been a huge amount of investment in GP-centres and services. That investment should be reinforced, rather than bypassed.

What services might we wish to offer from a GP-led health centre?

Wrong question again. I’m bored, let’s wrap this up.

The options

1. Do Nothing: this is not an option as we are required by the Government to establish a new GP-led health centre.

2. Ashfield and Mansfield area…

3. Hucknall area…

4. Newark area…

“we are required by the Government to establish a new GP-led health centre.” That says it all.

Locally managed services eat your heart out. Centralised diktat has won. Again.

Wrapping-Up

A real consultation process should be investigating whether health inequalities are best reduced by delivering services via GP surgeries or something more centralised. This consultation process doesn’t.

As I see it, the key problems are:

1. Health Inequality is a very fine-grained problem. Coarse grained solutions are not the best way to deal with it.
2. It should be a matter for local decision. This solution - as clearly as the nose on the elephant’s face that is sitting in the corner of the room - has been imposed centrally.

The Kicker

Here’s Alan Johnson MP (Health Minister) on Radio 4 this morning, talking about how access to local services will be improved and inequality reduced by putting one big new centre at one place in each Primary Care Trust. You couldn’t make it up.

You heard it from the horse’s mouth. He even managed to get “subsidiarity” into a sentence about doing things centrally that can arguably be done locally.

*** Head. Desk. Thud. ***