Editorial: No fairy godmother in NHS reform panto

It's almost Christmas panto time, but the NHS, and primary care in particular, is already echoing to cries of 'Oh, yes they do!' and 'Oh, no they don't!'

The subject of the farce is the role of GPSIs and, indeed, whether they have a future in the NHS.

Over the past six months we have seen the introduction of an accreditation system for GPSIs and heard health ministers declare that these doctors have a vital role in the move of services from secondary to primary care.

GPSIs have also been held up as the way to make significant practice-based commissioning (PBC) savings. A couple of weeks ago, GP brought you the story of an Essex GP whose specialist interest in minor surgery led to a £93,000 saving on carpal tunnel surgery (GP, 23 November).

On page 43 in this issue a practice in Lancashire explains how its massive PBC savings were in part due to GPSI services.

However, for a group supposedly central to these major reforms of the health service, there seems to be a great deal of negative feeling as well. In particular from the NHS Employers which would like to see the end of GPSIs completely and have any community-based services run by consultants and other hospital doctors. This is despite an original stated intention that the move to community-led services was to free up consultant and hospital time.

Now it has emerged that the Health and Social Care Bill before parliament, which covers medical regulation, is drafted in such a way as to make the revalidation of GPSIs particularly difficult.

These claims and counterclaims suggest a health policy in disarray. If those supposedly leading the NHS cannot agree on what form developments should take and, indeed, if one part of the DoH cannot draft legislation that supports other parts of policy, how are GPs ever going to know which direction their practices should take?

One plan to come out of last year's White Paper on primary care was that a number of care pathways would be developed to show how services could be moved to primary care.

Clearly we need those pathways now to help the DoH and managers address exactly who will deliver these services in the community, what is expected of GPSIs and from PBC, and what shape general practice will be in the future.

One vision and one plan is what's needed, not the current comedy of contradictory views and claims being aired at conferences and in statements.

Well either that, or a special NHS fairy godmother to wave her wand and deliver a happy ending of painless organisational change.

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