BMA call for cuts and reviews

Released 10/06/2010

Chairman warns of worrying times ahead and calls for cuts to management tiers and bureaucracy

The BMA has called for cuts and reviews across a range of NHS services, including reducing some tiers of management and bureaucracy.

In his speech to the annual LMC Conference, chairman of the BMA's GPs Committee Dr Laurence Buckman acknowledged that, while there had been record investment in the NHS in recent years, there were "worrying" times ahead, "because government needs to ensure that the pursuit of major savings and efficiencies does not adversely affect patient care."

With NHS Trusts under pressure to achieve up to £20bn of efficiency savings by 2014, Dr Buckman said: "Government must be determined to avoid wasteful and ‘un-evidenced' policies."

Dr Buckman listed a number of areas which could be "consigned to the dustbin of history". These include:

• Wasteful PFI schemes - The Private Finance Initiative is now funding over 100 new hospital schemes, valued at £10.9bn, but set to cost the taxpayer £62.6bn by the time the final payments are made in 2048.

• Management Consultants - £308.5 million was the total spent by Strategic Health Authorities, Primary Care Trusts (PCTs) and NHS Trusts on external consultants in 2007/08. In some cases, the NHS is paying external consultants up to £1,000 a day.

• Some tiers of NHS management - Many management jobs seem to exist with the sole purpose of supporting successive NHS reorganisations and top-down initiatives of the previous government. Micro-management of GP practices is expensive and unnecessary.

• The GP patient survey - Survey results have been consistent since 2006, yet last year alone it cost the government £13 million to run the survey. The view of the BMA's General Practitioners Committee (GPC) is that detailed and relevant feedback could be more usefully and more economically gathered locally from patient participation groups or local patient surveys.

• The bureaucracy of the NHS market - It's estimated that the ‘internal market' has increased NHS overhead costs from 8 per cent in 1991-92 to 11 per cent in 1995-96 and increased administrative staff by 15 per cent and general and senior managers by 133 per cent. Since 1995 Department of Health statistics show that the number of senior managers has risen by 91 per cent, more than double the 35 per cent increase in the total number of doctors and nurses.

Dr Buckman also listed areas which should be reviewed:

• Parts of NHS direct - NHS Direct still refers many of its patients on to GPs or accident and emergency departments and there is little evidence that it relieves pressure on GP or hospital services. While the NHS Direct website is a valuable resource and should be retained, the cost-effectiveness of other parts of NHS Direct should be reviewed.

• Choose and Book - Many practices find the e-booking element of Choose and Book useful. However, the "Choose" element is laboriously bureaucratic and requires a lot of expensive NHS staff time, and management. The system is now regularly used to ration demand and meet the 18 week waiting times target by PCTs. In practical terms it is often difficult for patients to exercise real choice.

• The current ‘consent to view' model of the Summary Care Record - the BMA agreed to the current consent model for the duration of the SCR pilots, on the basis that there would be a thorough independent evaluation before it was rolled out further. This is due to be published soon, and the premature roll-out of this scheme is costly and inappropriate.

• The building of new Walk-in-Centres and Darzi Clinics - existing centres need to be properly integrated with local services. However, new centres should only be opened after adequate consultation and an assessment of local need has been carried out.

Dr Buckman also warned against "spending money we don't have" on abolishing practice boundaries, which would not only be expensive but would "harm the NHS and patient care generally."

Addressing the profession, Dr Buckman said: "We, and our hospital colleagues, will all need to pull together in order to agree, if we can, what can stop without damaging patient care.

"We may have to accept that some parts of patient care may have to change too. Nobody will want that, but if it has to happen, at least let us see how we can minimise the effects on our patients."

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