Editorial: The DoH can no longer have its cake and eat it

Over the past decade, one of the government's key aims has been to ensure that public services are more responsive to local need.

It apparently believes there is no longer a place for a 'one-size-fits-all' approach and that decisions about which services communities require should be made at a local level.

Of course, much of this local decision-making is smoke and mirrors, for while PCTs are at liberty to decide how their funding allocation is spent, there is a plethora of centrally dictated targets and objectives that they, and the services they commission, must meet if they are to be deemed a success.

Local decision-making has also made it much easier for the government to dodge difficult questions. Earlier this year a Panorama documentary for the BBC investigated APMS contracts and the rise of the number of private companies providing general practice services.

Asked how many of these contracts had been awarded to private firms, health minister Ben Bradshaw could not answer. He said the information was not collected centrally because these were local decisions, made by local managers to meet the needs of local communities. This, he said, was exactly how things should be.

It is interesting that the DoH does not appear to take this view when it comes to GP-led health centres and polyclinics. For whatever reason, it has decided that the general public is deeply unhappy with access in general practice and the only way to solve this is by establishing a new, huge health centre in every PCT at breakneck speed.

And it is intent on doing so, regardless of the views of local communities and, in some cases, local managers. As GP reveals this week, less than half of PCTs are conducting formal consultations about their plans for GP-led health centres and among those that have there has been little support from the public.

How can PCTs be pushing ahead with plans for these health centres when local people either don't want them, or say they are located in the wrong place? What happened to the importance of local decision-making and public involvement?

These have been swept aside in the interest of pursuing the government's agenda - the DoH supports these tenets only when it suits its needs. Ministers and Whitehall bureaucrats, apparently, know best when it comes to improving access to primary care services and they have decided that polyclinics and GP-led health centres are the only way to do this.

The government wants to have its cake and eat it. But, if it is really serious about empowering communities, managers and frontline staff to deliver local services that meet local needs, then it must listen to what they want - even if it doesn't like what it hears.

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