Rationing healthcare in the English NHS : tensions, concerns and conflict for general practitioners

• Main Author: Street, K.
• Published: Queen's University Belfast 2014
• Subjects: 362.10941
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.677704

Since April 2013 and under the auspices of a controversial piece of legislation the Health and Social Care Act 2012 General Practitioners in their newly formed Clinical Commissioning Groups will be at the helm of the English NHS, making clinical and financial decisions for their respective communities. These 211 statutory bodies hold the reins on two thirds of the NHS budget. Accountability, I~'adership, and the potential impact on the patient are under the greatest scrutiny at a time of austerity and an increasing demand from an ageing and expectant public. This study is important because these new legislative requirements are not subtle policy nuances they are controversial, complex and inter-related and represent the biggest changes to NHS governance in the organisation's 65 year history. This research brings together the views and observations of fifteen key NHS policy makers, advisors, influencers and implementers as these new policy arrangements are implemented. These views are considered under three major headings: The General Practitioner and Reform, The Patient, and Governance, Leadership and Management. The data gathered from the interviews are considered within the context of theoretical literature on policy-making, implementation and research literature on health care reform. Despite the intention of the state to make commissioners more 'locally accountable to patients', and to enable 'clinicians to be empowered to make decisions' and to 'cut bureaucracy making £20b savings', the key findings of the study identify the significant lack of accountability in arrangements between Clinical Commissioning Groups and General Practitioners. The study found general disengagement of the key actors (General Practitioners) in implementing the legislative structure. Rationing and restricting access to services and the de-commissioning of services without wider public/patient debate has proved to be an ethical dilemma of General Practitioners, who in putting the patient first indicate that financial duties to balance spending and meet future spending cuts remain a significant tension, and a concern, bringing conflict to the NHS.