Cut market not care, doctors urge

British Medical Association
News
28 June 2010

By Lisa Pritchard

Scrapping the market in healthcare could help the NHS make substantial savings in the harsh economic climate, experts have claimed.

A BMA-hosted debate, An NHS Beyond the Market, concluded that scrapping the competitive market and the purchaser-provider split would not require costly and disruptive reorganisation, and could generate ‘substantial savings’ for the NHS.

The round table discussion involving representatives of the BMA, the NHS Support Federation, the NHS Consultants Association and the campaign group Keep Our NHS Public agreed that one of the more costly consequences of the NHS market in England had been the arrival and growth of transaction costs, such as payment by results.

Using an alternative method of funding for secondary care, such as block funding with some adjustments for volume and incentives for providing high-quality care, would reduce the amount of transactions and associated spending on factors such as management, the meeting agreed.

‘Perverse incentives of market structure’

BMA council chairman Hamish Meldrum said the proposals would ‘maximise the effective use of resources and help to ensure that patients get the services they need’ at a time of real economic challenge to the NHS.

He added: ‘The BMA has long been concerned at the costs and perverse incentives resulting from the market structure that has been imposed on the NHS. Many of the reforms of recent years threaten to erode the principles of free access, care based on need and risk-pooling.

‘We need a democratically accountable, local approach to healthcare delivery, with funding based on the needs of patients, and providers encouraged to cooperate rather than compete.’

The results of the discussion, held in April, were published this week before the BMA annual representative meeting, at which doctors are expected to restate their support for the association’s anti-market Look After Our NHS campaign.

Those attending the discussion, who also included representatives from academia, the Royal College of Physicians of London and patient organisations, also agreed that:

● Cohesion was critical for the NHS’s future, particularly in terms of integration and collaboration
● Clinician involvement in management was essential to drive reform
● There needed to be nationally agreed levels of funding and standards, alongside professionally formulated, locally delivered policies on prevention, diagnosis and treatment.

Dr Meldrum urged ministers ‘to be true to their word and listen to the views of frontline health professionals’.