The Health and Social Care Bill – what does it mean for ENT services?

The Health and Social Care Bill is making its way through the parliamentary process. It represents one of the most profound and significant changes to the commissioning (purchasing) of healthcare in the UK in decades. 

The current coalition Government has explained that healthcare provision must change. We have a population living much longer than ever before but, sadly, often with long-term chronic conditions which require on-going medical care, and often for long periods of time. We are also still gripped by the effects of the financial crisis, and with Portugal’s recent problems, it’s clear that there is still some way to go before we escape its consequences. These two problems alone demand enormous cost savings.

However, it seems that the Bill is less about changing healthcare provision, but rather a change to how medical services are bought and paid for. Over 80% of the NHS purchasing budget is to be given to GPs to manage. This has clearly caused widespread concern and many medico-political commentators have highlighted the potential conflicts of interest the new commissioning arrangements raise. General Practitioners referring to “any willing providers” in which they may have a personal and financial interest, the ability of GP consortia to re-distribute a share of “profits”, and the worry that, no matter how much it is denied, the final arbiter of care pathways will be cost, are just a few of the more serious examples.

In secondary care (hospitals) there is also great concern. One of the biggest worries is that by removing much of the straightforward, “profitable”, elective work, there is a risk of destabilising hospitals and therefore the provision of emergency care – an area of medicine that is continuing to grow!

The argument for the GP as commissioner of their patients’ healthcare is that they will act as a true advocate, and have the knowledge to best decide what should be purchased, and, hopefully, what is good value for money! However, whilst this looks and sounds good in theory, it may not work in practice.

First of all, no-one has really looked at the issue of what is good value for money? This will become rationing by any other word. However, there is a limited pot of money and, at some point, the collective “we” need to decide what is appropriate to be provided by the state for its people. Or perhaps GPs are being set up to be the “bad guys” when they are forced to ration?

Secondly, and probably more pertinent to ENT services, is that many GPs don’t seem to know what they should be buying. ENT specialists are being asked almost daily: what should a reasonable ENT service look like, and what are appropriate ENT services to buy? It will probably be difficult to avoid commissioning emergency services, cancer care and most paediatric ENT services. The rest of ENT service relates to quality-of-life rather than life-threatening problems, and so is open to debate? However, with undergraduate training being what it is, most GPs will not suddenly acquire sufficient ENT skills to become ENT experts. 

This is where an independent group of highly trained ENT surgeons becomes extremely valuable. The Surrey and Hampshire ENT partnership will continue to work to provide the most up-to-date, comprehensive, quality ENT service to all of its patients and customers, whether or not such treatment is available on the NHS.