Chris Lancelot: Could evolution also save the NHS?

Last week, I discussed how Darwinistic evolution applies not just to the natural world but to all autonomous units - biological or non-biological - competing for finite resources.

GP practices are an excellent example: provided there is no external interference from managers, good-quality practices will thrive while inefficient ones go to the wall.

But can we apply this logic to the whole NHS? At a time of financial cutbacks could we use evolutionary principles to reduce costs while maintaining quality?

The answer is undoubtedly, yes - but there is an important caveat. Evolution by natural selection only occurs when several conditions are met: there must be competition; this must be for finite resources and between autonomous entities; there must be no external interference or preferential treatment; and there can be no rescuing of failed entities.

In the NHS, primary care comes closest to satisfying these requirements, which is why general practice works so well. Similarly, in secondary care, a variety of providers creates the competition vital to Darwinistic evolution. The DoH's plan to introduce more providers will create competition which will drive standards up and costs down - but only if there is no external interference through preferential pricing or favouritism, which unfortunately is not the case.

However, primary and secondary care is where evolution in the NHS currently stops, because the remainder of the NHS - its core managerial structure - has no competition and therefore experiences no natural evolutionary pressures. Because there is only one PCT in any one area, only one SHA for each region, and only one DoH, then Darwinistic evolution cannot apply: and it is significant that these groups are the most wasteful and inefficient in the NHS.

If only these central structures could experience the refining effects of compet-ition, evolution would inevitably occur and the NHS would be free of its resource-sapping over-management, its quangos and its complex, non-evolved and totally unfit central IT system. What a thought!

But how can a monolithic organisation experience competition, other than from private practice? More next week.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

First COVID-19 jabs to target care home residents and staff under new JCVI advice

First COVID-19 jabs to target care home residents and staff under new JCVI advice

Older adults living in care homes and staff working there will be first to receive...

GPs unable to veto virtual fitness to practise hearings during pandemic

GPs unable to veto virtual fitness to practise hearings during pandemic

GPs facing fitness to practise investigations during the COVID-19 pandemic will be...

Government rejects major NHSPS overhaul - but changes 'could ease GP service charge disputes'

Government rejects major NHSPS overhaul - but changes 'could ease GP service charge disputes'

A government review has rejected calls for a major overhaul of an NHS Property Services...

RCGP urges GPs to collaborate with pharmacies on flu jabs this year

RCGP urges GPs to collaborate with pharmacies on flu jabs this year

The RCGP and the Royal Pharmaceutical Society have called on GP practices and community...

GP appointments rising fast as COVID-19 cases 'near 10,000 a day'

GP appointments rising fast as COVID-19 cases 'near 10,000 a day'

GP appointments have risen rapidly in recent weeks as schools returned, according...

COVID-19 impact on medical schools risks 'serious damage' to future NHS workforce

COVID-19 impact on medical schools risks 'serious damage' to future NHS workforce

Medical training and the future NHS workforce could be seriously damaged by the financial...