NHS reforms fuel rise of high street healthcare clinics
The Health and Social Care Bill has gone though more than a year of debate and more than 1,000 amendments and this week it was finally passed in the House of Commons - but what does this mean for patients living in England?
If you want to know what the NHS reforms will mean for patients, Specsavers in Cambridge is a pretty good place to start.
Upstairs in a small office, audiologist Georgie Noble is giving patient Margaret Manson some tips on using her hearing aid when answering the phone. Mrs Manson had it fitted at Specsavers for free on the NHS.
Specsavers has a contract with the health service to run clinics twice a week for NHS patients. GPs ring a booking line and, normally, a few days later the patient is seen at the clinic.
"The feedback has been really good so far. I believe from the referral to the first appointment it is a lot quicker," she tells Radio 4'sThe Report.
Mrs Manson was keen to get her hearing aid as soon as possible:
"I asked 'how long will I have to wait for it?' and they said 'you don't, you take it away with you' which I thought was a fantastic service and I walked out of here like a new person," she says, happy she can now hear the world more clearly.
The alternative to this was a trip to the local Addenbrookes hospital - a trip Mrs Manson did not relish: "I'm not a great lover of hospitals by a long way and I was lucky enough to choose to come here."
Cambridgeshire had already started down this road before Health Secretary Andrew Lansley decided to give GPs the power - and most of the NHS budget - to buy healthcare in their local area.
Sushil Jathanna, chief executive of NHS Cambridgeshire says the reforms will mean a lot more of this kind of service:
"There is no need for people to be referred to hospital unless it is a complex procedure or a complex consultation," he explains.
Mr Jathanna believes many hospitals, especially the big, specialist ones like Addenbrookes in Cambridge will welcome this:
"They don't want to be doing things that could easily be done in the community.
"A lot of things that hospitals currently do, we know can be done in primary care and community services."
An hour outside of Cambridge in the unyielding Fens, Lesley Wright is having an ultrasound scan in a mobile clinic set up behind a GP practice in the village of Doddington.
This is another local service being delivered by a private company which travels around the Fens performing scans for people in different locations.
"I would have had a 40 or 50 minute drive to Peterborough or Huntingdon," Mrs Wright says - but today she had a five minute trip down the road.
"I don't have the stress of a long journey, it's on my doorstep," she says, emphasising the all important C word - choice.
"When I had a choice I said definitely Doddington."
Cambridgeshire is one of the pathfinder clinical commissioning groups piloting the plans for GPs to buy local healthcare.
Chairman of the Cambridgeshire Clinical Commissioning Group Simon Hambling says they tried to get the NHS to deliver a local ultrasound scan service but "they thought it was too difficult in terms of moving people away from the central location".
Under the new reforms GPs will be able to commission more of these services from whoever is qualified to provide them, whether it is the NHS, charities or private companies.
However "the vast majority of services will remain the business of the NHS," says Dr Hambling, but for smaller niche services "we will look for providers that can adapt and provide services the way we want them."
GPs argued for years for a greater say in how the NHS budget should be spent, taking this power away from PCT managers.
In some of the areas where they are piloting GP commissioning, some doctors are starting to have second thoughts.
Dr Peter Bailey was vice-chairman of the Cambridgeshire Clinical Commissioning Group until he recently retired.
Initially an enthusiastic supporter of the reforms, he remembers the first time he sat down with his colleagues who were preparing to take over control of an £850m budget:
"Most of us felt a little under-prepared," he admits.
"I thought 'who here actually knows how to negotiate an NHS contract?' Not one of us." Dr Bailey says he was left feeling "like an enthusiastic amateur".
Building bridges with GPs
In the past doctors had been able to blame managers for budget decisions, but under the new system the buck stops with them as the previous layer of budget managers working for PCTs is being abolished.
When Dr Bailey realised how the new system would work, he met the Health Secretary Andrew Lansley and the NHS chief executive Sir David Nicholson to tell them the plans were unworkable.
Abolishing PCTs leaves GPs exposed. While they wanted to share the responsibility of commissioning, Dr Bailey says GPs are now like captains forced to control a ship:
"You're not really sure how the controls work, you're not a great navigator, you don't know how the engines work. That's a bit scary."
Now that the bill has passed through Parliament it will be up to GPs like Dr Bailey's colleagues in Cambridgeshire to make sure that the new system of doctors buying care runs smoothly.
At the same time, the government realises it has to mend bridges with GPs and their professional bodies.
"You can look back and you can think of ways in which one would have done it better. I'm not going to say it's marvellous because clearly it wasn't," admits Health Minister Simon Burns.
Mr Burns is hoping that opponents can put aside their differences with the government to make sure the transition is as smooth and as successful as possible - "because we all have the basic interest of the NHS at heart," he says.
Many GPs remain sceptical, believing the reforms are a way for ministers to pass the blame for cuts in the NHS onto doctors.
"We can see all sorts of places this is not going to work," says Dr Laurence Buckman, chairman of the GP's committee of the British Medical Association, "but worse, we will get blamed for it because it'll be the GPs in charge."