Chris Lancelot: Why a leaner, meaner NHS would be good

Pharmaceutical shares are down, and at least one drug company has laid off a number of reps: this means less money for sponsorship and fewer educational meetings.

Virgin Healthcare has pulled out of negotiations to provide services in Swindon. Some commercial providers may withdraw from the primary care market and there are rumours of consolidation among companies building up groups of small practices, because their expected profit is not materialising.

All this has taken considerable pressure off existing GP practices. The lesson is that general practice is about as economical as it can get.

The biggest problem for healthcare is the massive black hole looming in the government's finances. As the recession bites, tax revenues will fall massively, while outgoings on unemployment pay and bank bail-outs will rise steeply. The DoH has guaranteed current levels of income for the whole NHS until 2011, and core contract income for GMS practices until 2010 - but will there be sufficient tax money?

When New Labour came to power the NHS cost £35 billion a year. Ten years later that same organisation costs a whacking £110 billion - for very little extra output. Given its present funding difficulties the government should recognise the huge managerial inefficiencies that have been allowed to creep into the NHS and extrude these before they do further damage.

Nationalising PFI at an honourable price is one option. But PFI is only one strand of a complicated web of NHS waste which the DoH will probably not want to address, especially as it introduced these practices in the first place. The government has said it wants to spend its way out of recession - risking huge inflation and long-term tax-rises in the process - so presumably it will keep NHS investment the same, protecting it from the recession.

While this is good news for individual doctors and nurses, it represents a missed opportunity for the NHS itself. Private firms and individuals are having to cut back: why shouldn't the NHS? A leaner, meaner NHS would be good for everyone - except the commercial firms, the management consultants and the paper-pushers.

Dr Chris Lancelot, a GP from Lancashire. Email him at GPcolumnists@haymarket.com

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