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Medicine and life |
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Five things patients hope for from GP commissioning
The White Paper, Equality and excellence: liberating the NHS, sought, inter alia, to explain how GP consortia might work with community partners and other health and care professionals to design services that are responsive to patients and the public. This carries with it an ominous sense of déjà vu and of paying little more than lip service to patient involvement. Since the gratuitous abolition of the imperfect but reasonably objective and effective Community Health Councils in 2003, we have seen the rise and fall of a string of faltering, ill-explained and ill-advertised acronymic ‘patient involvement’ organisations; ACHCEW, Patient Forums, CPPIH, LINks and PALS. Ask any patient or member of the public what any of these organisations did or does, and I’ll guarantee that the question will be met with blank incomprehension. The only people who have even the faintest idea what they are or were are a few bureaucrats in the Department of Health. All of which is a rather roundabout way of saying that patients, carers and the public really must be involved in decisions about healthcare commissioning, and that there is an opportunity and a moral obligation on GP Consortia to facilitate that by including patients and the public in their memberships. The second thing patients would wish to see is equity of service provision across the UK, in terms both of the range and quality of services, and of cost. The Quality and Outcomes Framework (QOF) shows all too clearly how target-setting and associated financial incentives can disadvantage substantial groups of patients, distort clinical priorities and drain primary care of flexibility. Prescription charges, now unique to the NHS in England, make a mockery of ‘healthcare free at the point of delivery’ and must go. Given that more and more services are being moved ‘closer to home’ (a euphemism for devolving specialist care to GP practices), it is essential that there should be safeguards to ensure that excellent specialist treatment is available and both readily and promptly accessible. And last but certainly not least, any move away from target-driven healthcare must under no circumstances be allowed to extend waiting times. Having spent the past eight months in severe pain and increasingly immobile as a result of a failed emergency whole-hip replacement, and having waited six months for the necessary revision surgery, I say this with real feeling - and I am well aware that there are a great many people with problems far more severe than mine. Peter Lapsley is patient editor of the BMJ.
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