Replacing the NHS Internal Market with a new Patient-Doctor Compact
This extensive proposal is only part of a far-reaching composite policy recommendation for the Department of Health, the Department for Work and Pensions and the Department for Education.
Patient advocacy has long been an ideal that emanated from the Welfare State and it can be attributed to the Beveridge Report. However, over time the economy, population demographics, medical science and patient expectations have changed and distorted the congruity of the tripartite compact between the state, the medical profession and the British public in both health care and social provisions.
In the United Kingdom, the entry point for accessing medical attention and a myriad of healthcare needs is through the General Practitioner (GP). The remit and scope of the GP has changed in the 40 years that I have worked as a doctor. There is less emphasis on traditional acumen-based diagnostic skills and greater dependence on standardised protocols with the result of fragmentation of care based on artificial divergence. This ethos which runs counter to holism also has a powerful economic imperative and is subject to rigid management.
As a consequence, patients are commoditised and the flow between primary care offered at GP surgeries and secondary care in hospitals has become monetised. Flawed policy changes continue amidst variability in the standards of management and the calibre of medical personnel.
Although these burgeoning difficulties are acknowledged, no major attempt in four decades have addressed them adequately and the recourse to outsourcing provision and management accompanied by huge investment to taxpayers’ chagrin have not proved satisfactory.
Many of the problems encountered in the NHS have repercussions beyond the craft of clinical professionalism. In particular, the ill-effects are felt in productivity, employment and benefit payments.
Our proposed changes include the way doctors are trained, the way they work, the relationship between the doctor and the patient and the contribution of the public to their care needs which at present is state dominant with little regard to financial autonomy.
Sovereign will deliver the most significant policy changes since the inception of the NHS to benefit not only health and social care but also our economic performance and industrial output. Over the longer term, society will reap the advantages of accountable care and responsible citizenship.
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