In 2016, the government made it abundantly clear that it was not going to match demand for health and social care services with income tax. Services will have to somehow survive with a decade of flat-line funding (in the NHS) and huge cuts (in social care) while demand grows 4-6% year on year. The lame hope is that moderately un-progressive council tax rises and selling family homes will save social care, and that the NHS can plug a multi-billion underfund by making eye-watering efficiency savings without killing too many people on the way. Private companies and charities are now being encouraged to fund health and social care services in the form of ‘social investments.’ The NHS is also being ‘incentivised’ to generate income by expanding the private services it offers, ‘partnering’ and ‘innovating’ with the private sector and selling its services abroad. Likewise private companies can take over or partner with existing NHS services in ‘a truly mixed market where patients are blind to the provider.’ Labour started the commercialisation of the NHS, and VirginCare may well finish it.
The Sustainability and Transformation Plans (STPs) that are to be rolled out across England have the smell of untested and expensive management consultancy, and will inevitably result in specialised services being concentrated on fewer sites. Emergency departments and maternity services will merge, sometimes for valid quality reasons – concentrating resources and expertise – but often for reasons of cost containment or because poor planning and lack of investment in manpower has meant that units cannot be safely staffed. This will inevitably mean longer journeys for urgent and routine care, and extra demand on an NHS ambulance service that already can’t cope. Cue an opportunity for more private ambulance services. NHS spending on private ambulances for 999 calls in England has trebled in four years. Ambulance trusts paid private companies and voluntary organisations £68.7m to attend emergency calls in 2015-6, compared to £22.1m in 2011-2. The ambulance service in England took 861,000 emergency phone calls in March 2016 – or 27,800 a day – compared to 22,400 calls a day in March 2015, a rise of 24%. The private sector will be eager to do more NHS business, but can quality, safety and paramedic training be guaranteed?
Many patients have to wait over a week for an NHS GP appointment, and until recently the provision of private GP services has been relatively sparse. But there is now a modest explosion of entrepreneurial GPs offering private phone, online and Skype consultations, ‘Uber GP’ home visits and face to face consultations. NHS GPs aren’t allowed to see their own patients privately, but they can see anyone else’s patients. A company called Doctaly (sic) is now recruiting NHS GPs to use their own CQC accredited practices to see patients privately. You choose a GP you like the look and language of online and get a 15 minute appointment for 1 problem only, starting at £39.99. The doctor doesn’t keep any records of the consultation – you take them home with you. PushDoctor offers a similar service – hooking you up with NHS doctors in the time they have put aside for private practice
Alternatively, Now GP and Babylon let you arrange a video consultation with a GP via an App on your smartphone. The App hasn’t mastered intimate examination yet but you can lean your lump or rash into the camera for a tricky diagnosis. Or you can bypass the doctor altogether and use the Artificial Intelligence symptom checking software. Now GP delivers prescription medicines directly to your door. Babylon was founded by Ali Parsa, formerly of Circle, who aims to put ‘an affordable health service into the hands of every person on Earth’, starting with the UK and Rwanda
Or if you fancy splashing out on a visit, GPDQ (GP Delivered Quick) can arrange for a GP to visit you at home, office or hotel in central London or Birmingham between 8am and 11pm, 365 days a year. The average wait is 90 minutes and an app allows you to track your GP’s progress with live ETA updates. Prices start from £120 for a 25 minute consultation with a GMC accredited GP with rigorous customer service training. In contrast, a GP working in the NHS receives on average £136 for looking after a patient for an entire year, which shows what great value the NHS is. Under this government, NHS hospitals can generate up to 49% of their income from private patients, so why not NHS GPs? As the NHS and state social care become poorly funded services for the poor, the government hopes those who can afford to go private will pay twice, jump the queue and ‘take the strain off the state’. But with NHS doctors providing extra private services, will the NHS survive?
MDs Health Revolution is touring the UK. Details here