NHS Reforms

Operose Health Ltd, the UK arm of the large US healthcare insurance provider Centene Corporation, is to take over AT Medics, one of the leading providers of primary care services in London.

AT Medics operates 49 GP surgeries across London, providing services to around 370,000 people, with 900 employees, which until the takeover was owned by six GP directors.

lowdownnhs.info/news/us-takeover-of-a-network-of-gp-practices/

I was wondering, much has been said about rewarding NHS staff for their work during Covid. What about handing control of the NHS over to them? It would be run by a board consisting of representatives of the staff, people from professional organisations such as the BMA, RCN, etc and the unions representing office/cleaning staff- like UNITE. The Health Secretary could sit on it but not control it. So the control would be taken out of government hands and the idea of things changing every 5 or 10 years would go. Anyone who has worked in the NHS do you think it could work?

Just wait till they combine the NI number and the NHS number, then the Government will really have you by the short and curlies!????

growstuff

Mine is ten digits. It's not the same as your EMIS number, if you have one for ordering prescriptions online, etc.

All these numbers, I'm starting to feel like The Prisoner...

Thanks for explaining, B9exchange.

That’s a difference between England and Wales then growstuff, as our GP practices are not ever managed by commercial organisations, the Health Boards manage all NHS services.

One problem with pooling resources is that CCG/STP boundaries aren't the same as local authority boundaries.

Mine is ten digits. It's not the same as your EMIS number, if you have one for ordering prescriptions online, etc.

MaizieD

^All NHS communications rely on the 10 character NHS number for identification purposes. There is one number for each person allocated at birth registration. Social care do not have access to the database and do not use these numbers. Until it is forced to do so, no meaningful joined up working can take place.^

I assume that this is because social care has not been part of the NHS.

I'm curious about these 10 figure NHS numbers. Mine (as in the one I have amongst my earl years documentation) is far from being 10 figures. I don't recall any notification it had been changed. So there's a little mystery for me

They were changed from the four letters, three numbers format several years ago. You can look yours up here www.nhs.uk/nhs-services/online-services/find-nhs-number/ but it will be on all your prescriptions and correspondence.

Casdon The traditional model of GP practices is dying out in England too, for the same reason. Some GP practices are effectively owned by profit-making companies, who aren't necessarily medically qualified. The GPs are paid a salary. That's why so many of them are being taken over by companies such as Babylon. I can't see the traditional family GP practice surviving.

Thanks for the link to the Kings Fund document, which I'll read when I have time.

All NHS communications rely on the 10 character NHS number for identification purposes. There is one number for each person allocated at birth registration. Social care do not have access to the database and do not use these numbers. Until it is forced to do so, no meaningful joined up working can take place.

I assume that this is because social care has not been part of the NHS.

I'm curious about these 10 figure NHS numbers. Mine (as in the one I have amongst my earl years documentation) is far from being 10 figures. I don't recall any notification it had been changed. So there's a little mystery for me

Blossoming

MaizieD every communication I receive from a hospital or from my GP has my NHS number on it, as do the online services I access. I don’t know who issued it in the first place though.

The NHS did, when you were born.

I was querying a statement which implied that it could change. As far as I'm aware it's for life. But I could well be wrong.

This is a good paper from the Kings Fund about the integrated care systems in the other nations:
www.kingsfund.org.uk/publications/integrated-care-northern-ireland-scotland-and-wales
I think one thing highlighted on the news that was absolutely correct was that it takes a long time to build trust between organisations, and pooling budgets for community care services is the way forward.
I don’t know about the other nations, but in Wales the directly managed service model for GP practices is growing, particularly in the more deprived parts of the country, as the cost to buy into a GP partnership is increasing prohibitive and adverts don’t attract candidates because there aren’t sufficient people choosing general practice for their career.

MaizieD

^There is a plan to centralise services even further, so it is inevitable some general hospitals and A&E hubs will be shut and people will have to travel further. There is also a plan to introduce a remote GP service, which could be run by American providers (or anybody) from anywhere.^

It really doesn't sound at all promising, does it?

and the lack of a common NHS number being used in social care.

Can you clarify this, B9exchange ? What 'NHS' number are you talking about?

All NHS communications rely on the 10 character NHS number for identification purposes. There is one number for each person allocated at birth registration. Social care do not have access to the database and do not use these numbers. Until it is forced to do so, no meaningful joined up working can take place.

Tweedle That's the same as England. I was wondering how Scotland achieves a more integrated service, as claimed.

growstuff in order to get the GPs on board for the introduction of the NHS, they were offered lucrative contracts so, in effect, they were subcontracted to the NHS, rather than employed by the NHS. Currently, GPs run their surgeries as a business and charge the NHS for its services.

Some dentists and pharmacists are employed directly by the NHS, usually the ones who work in hospitals. Dentists usually own or work for a private firm which is paid by the NHS for NHS work. It is similar for pharmacists. For example, your friendly Boots pharmacist who gives you your NHS prescription is paid a salary by Boots and Boots is paid for the prescription it provides. The pharmacists in hospitals are employed by the NHS.

Similarly some of the other professions, nurses, midwives, physios etc can work for and be paid by the NHS but can choose to work in the private sector.

growstuff What you say is quite worrying. There has been so much criticism of the way the procurement of PPE was handled - with companies that had no experience in that type of manufacture being handed out millions of pounds.

I had hoped that the Conservatives had seen the error of their ways but your post sounds a warning. If the services are not kept "in-house" but are still being privatised, does "cutting bureaucracy" really mean there will be no proper accountability? I think this is so important that opposition MPs of all parties should investigate this in more depth.

MaizieD every communication I receive from a hospital or from my GP has my NHS number on it, as do the online services I access. I don’t know who issued it in the first place though.

JayLucy I so agree. I was a buyer for the NHS many years ago and did things properly. As a ‘back room’ employee I knew everything I saved helped the frontline. Then I saw following reorganisation a proliferation of works officers and press officers etc all spending a fortune on palatial offices when wards couldn’t even afford curtains.

I lament the loss of catering officers who knew giving patients decent meals helped their recovery. Now when my dh was in hospital the food was atrocious. The soup was wallpaper paste with a different colour and flavour stirred in everyday.

I can’t see the latest dis reorganisation being helpful.

How does that work in practice? Are GPs, dentists, pharmacists, etc all salaried? Who is the employer and how are the finances organised?

As an NHS worker for nearly 40 years, I would say that the NHS in general is sick to death of ‘reorganisations’ which just turn out to be tinkering at the edges causing extra expense to the NHS and confusion and extra work for the staff.

The NHS does require reform. There is no doubt about that but, what I think is that, rather than a little bit here and a little bit there, it should go right back to scratch and start again. The 1948 plan suited the times but, it was over 70 years ago and things have moved on. It would take time and cost a lot of money to set up a new system but, would probably be cheaper in the long run. Unfortunately, ‘long runs’ are not built into our political system. Ideally, governance of the NHS should be independent of politics but, that will never happen because the governing political party holds the purse strings.

I’m surprised nobody has mentioned the fact that the other nations in the UK already have devolved responsibility for health, and run quite differently to England. In terms of integrated health and social care services we are a long way ahead. The hospital services are not perfect by any means, but for community care, integration removes a lot of barriers to people working together, and putting the person first - for the first time primary care, i.e GPs, dentists, pharmacists and optometrists are included as well, which is vital.

My bet is the first thing to be even more privatised will be the GP service. Companies such as Babylon Health and another one whose name I've forgotten is already offering remote consultations (apart from high cost patients, of course). This is leaving the rump of GP surgeries with the high cost patients, such as the elderly and pregnant. One of these companies is even introducing "chatbots", which mean that patients won't even speak to a real clinician.

Having worked in the NHS, the best thing they can do before they make any reforms is to actually ask the people that work there and I'm not talking the CEOs etc, but the cleaners, nursing assistants, porters, nursing staff, radiographers, physios, doctors just to start with.
In fact , get rid of the CEOs with their huge salaries and pay offs when they leave for whatever reason.
Bring all of the laundry , catering and ancillary staff back into in house so that any problems that occur can be sorted on the spot rather than by some faceless jobsworth that doesn't really give a toss because it doesn't affect them !
That's just for starters!

Then you realise just why this has to go through even though we have the NHS in the midst of a pandemic, because getting it through quickly will give the Tories 4 years of control of everything. By the tiime there is another election what will be left?