Is this one big idea too many for the NHS?

How would you feel about carrying out all the post-operative assessments on patients from your local hospital?

In case you missed the national newspapers in the dying days of December, the DoH’s clinical director for primary care has suggested that this work be moved out of hospitals to save the NHS nearly £2 billion.

Dr David Colin-Thomé’s full report will appear later this month and he has refused further clarification until then. But the department clearly wanted the idea out in the open and provided an unofficial press release with comments from the man himself.

This talks of how hospital doctors are having to ‘squander hours in the consulting room at great cost to the NHS’. Even Dr Colin-Thomé, a Cheshire GP, says that the current system is like ‘asking a Michelin-starred chef to cook microwave meals all day’.

He clearly thinks that his primary care colleagues should be the people switching on the microwaves — after all, they have very little else to do.

The few details that we are given suggest that this will be a blanket policy change, with all patients assessed by their GPs after surgery. What about those who want to exercise some patient choice? Does that go out of the window as the 18-week wait target looms ever closer?

The boundaries between secondary and primary care are obviously attracting a huge amount of attention as PBC and Payment by Results take off, but this looks like one big idea too many. Dr Colin-Thomé talks about GPs having ‘extended budgets for patient care’, and he expects them to be happy to offer the extra services to patients. Does that mean it will simply be an option for practice-based commissioners? Perhaps their budgets, or even savings, will be top-sliced?

Frankly, it’s anybody’s guess. But the latest NHS workforce statistics make it all the more important that Dr Colin-Thomé gets his figures correct. The experts are predicting a major shortage of GPs by 2010, and at the same time 3,200 more consultants than required. Maybe those surplus hospital doctors could help out in the kitchens?

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