As MPs condemn GPs’ out-of-hours services, Skipper sighs and asks if government can manage the public sector efficiently. To be fair, he’s not talking about GPs, but he does cite on-going IT procurement problems at the NHS and his points remain: public sector culture makes people hard to manage and it lacks the clear success measure that is profit.
Late last year, I left my GP because his surgery was scruffy, his support staff surly and he was difficult to get hold of. Moving wasn’t easy because other local doctors make it difficult. I’d visit one day to be told they only accepted patients at 10am on Thursdays on a first-come-first-serve basis. A couple of weeks later this had changed. Meanwhile, the walk-in centre at our new community hospital is great, but limited by being nurse led… I hardly had to wait for them to patch up my animal bite, but getting to a GP took hours and a late evening journey to another hospital.
Yet, ironically GPs are located in the private, rather than the public sector. Most usually self-employed, they work for the NHS under contracts many feel too generous and it is at the negotiation of these contracts that things get tricky. The experience of the unambiguously public sector community hospital (efficient despite the absence of a profit motive) being let down by self-employed GPs fits well with all that I’ve read.
The private sector lets down the NHS because it operates outside of a free market. Free healthcare for all rightly removes the price mechanism by which doctors would otherwise regulate demand and leaves them free to supply a level of healthcare to suit themselves. My old GP clearly had no desire to compete for patients by improving his offer, choosing instead to keep his costs down.
The solution to improved frontline healthcare lies in making GPs NHS employees and housing them in small community hospitals operating on a walk-in basis… and in patient’s homes.