NHS Reforms: Can Doctors Manage?

UK health secretary Andrew Lansley's National Health Service reforms have been labelled the most radical rethink of the health service since its inception just over 60 years ago. They are changes that will affect almost everyone in the UK in some capacity.

With over 1.5 million employees, the NHS is among four of the largest employers worldwide (Wal-Mart and the People's Liberation Army of China employ more.) So any reduction in headcount will not only impact the service directly, but will have a ripple effect on the many businesses that feed into it. (Some time before the NHS overhaul, Nigel Cooper, the managing director of events company Motivcom, predicted public sector cuts could be harder on UK businesses than the recession itself.)

Potential redundancies in the UK's largest employer are a foregone conclusion, with the Guardian estimating some 30,000 jobs at risk. The bulk look to come from the phasing out of 152 Primary Care Trusts and the 10 strategic health authorities -- managerial and admin jobs that are seen as adding an unnecessary layer of bureaucracy to patient care.

Lansley's plan -- to hand to doctors the control over commissioning care and to involve patients more in choosing how they are looked after -- effectively turns the NHS upside down. It's radical in context, but it mirrors broader business moves to decentralisation: management responsibility is devolved to a wider range of people close to the customer, collaboration becomes integral to productivity. HCL's Vineet Nayar argues for the same type of approach in his book, "Employees First"; John Timpson's been practising upside-down management for years.

Of course, these are tiny organisations by comparison to the NHS. Will upside down management work when applied to the nation's healthcare provision? How easy will it be for GPs to form consortia (and shouldn't such groups involve a wider range of stakeholders anyway)?

There are concerns that GPs may lack the necessary management ability (not to mention the desire) to oversee recruitment, resource allocation and patient care. David Furness of think tank Social Market Foundation claims "GP commissioniing risks handing real control of the NHS to vested interests to the provider side, as GPs simply won't have the muscle to drive through change."

This seems a little patronising, especially if GPs start collaborating with a wider group of professionals -- nurses; voluntary care providers; consultants. A medical degree may not include the finer points of budgeting, but project management and co-operation are requisites. Anyway, there will be help on hand from the defunct parts of the NHS -- managers who can help GPs with practice management.

Of course, there are a raft of other questions, from how individual pay and benefits will be affected to how changes will impact innovation and whether Lansley's created a 'back door' for private healthcare to creep through.

But let us know what you think: is radical change what the doctor ordered or has the coalition cut too deep?

(Image: takomabibelot, CC2.0)