Independent Healthcare Providers Network boss David Hare reflects on some important recent national events affecting doctors and their patients.
It has been very interesting to observe Chancellor of the Exchequer Jeremy Hunt’s behaviour around the NHS and social care since entering No.11 Downing Street.
I say that given how strong he was from the backbenches and as chairman of the Commons’ Health and Social Care Select Committee about the need for continued investment in the health service – and specifically the need for a fully funded, costed, long-term workforce plan for the NHS.
One thing we were particularly pleased to see when he delivered his much-anticipated Spring Budget was some acknowledgement of the important role that employers – through occupational health – can and should play in supporting the health and wellbeing of employees.
A £400m investment was announced to increase employment support for mental health and musculoskeletal (MSK) problems. This will involve turning community hubs and leisure centres into MSK hubs so more people can access treatment.
The Budget also announced the expansion of funding for the upcoming small- and medium-sized enterprise subsidy pilot study for occupational health services, as well as bringing forward two new consultations seeking to improve occupational health, covering potential regulatory options and tax incentives.
We have worked hard to make this case to the Government in recent months, so it was very encouraging to see these steps taken and we look forward to further progress through the consultations.
One of the longest-running workforce issues facing the NHS particularly has been around pension rules, which have impacted senior doctors across the country.
Their punitive impact undoubtedly has had an enormous impact and completely disincentivised senior medical colleagues particularly from continuing to work – in some cases, it literally cost them to do so.
As reported in Independent Practitioner Today last month, Mr Hunt announced there will be an increase to the annual pensions tax-free allowance from £40,000 to £60,000, with the aim of incentivising highly-skilled individuals to remain in the labour market for longer.
Meanwhile, the pensions lifetime allowance, which currently sits at £1.07m, will be abolished entirely. There had been earlier briefing that the cap might just be raised.
The policy itself was pitched quite clearly and overtly to target and resolve the issue for senior doctors specifically.
In that respect, many colleagues have welcomed it, including the BMA, so a tick in that box and many Independent Practitioner Today readers will doubtless welcome these developments.
However, by avoiding some kind of ring-fencing around doctors – admittedly this would have been very complex – it ended up taking fire for being a windfall for all top earners.
Junior doctors’ strikes
We were looking closely to see what the impact of the junior doctors’ strikes might be on services across our members and we stood up a working group with clinical leaders from across the membership.
So far, as I write, the impact appears to have been relatively minor. That is thanks in many respects to the support and willingness of senior medical colleagues supporting the NHS and due to pragmatic and sensible management by private providers.
Most of our members have reported only minor impacts to planned lists and activity.
This in itself raises an interesting question about workforce. Some critics of the independent and private sectors have in the past used a ‘robbing Peter to pay Paul’ argument when considering the workforce.
There is no point – the argument goes – in commissioning more work to the independent sector, as the people delivering it all work in the NHS, so there is no additionality – the workforces are the same.
One could see the strikes, and the comparatively modest impact on the independent and private sector, as evidence that perhaps there’s a much greater level of ‘insulation’ after all. Perhaps there is not so much ‘fishing in the same pond’ going on? It’s something we will be considering.
Waiting list misery continues
More widely of course, the knock-on impact of the strikes is almost inevitably that more patients are not being seen in planned care.
The NHS reported that 175,000 appointments were missed as a result of the first action, with a likely 250,000 more impacted by the second.
That is a huge number of patients impacted, appointments to rearrange and procedures to re-book. With over 7.2m people still on the waiting lists, we must hope that this does not turn into a long-running issue or patients will suffer the consequences.
Patients vote with their feet
The travails of the NHS are undoubtedly having a continued impact on consumer behaviour.
We are seeing consistent evidence of this through ever-increasing market research – whether that is public polling or analysis by insurance companies and others.
We have just completed a significant body of research showing some very interesting findings and will be publishing these in due course.
It is becoming clear that members of the public are starting to vote with their feet in terms of pursuing private healthcare – whether that is operations, diagnostics or primary care. And it is not necessarily just in the UK either.
On the latter point, we need to remind the public that the UK remains one of the safest and best places in the world to receive medical treatment.
There have been several stories in the media recently about patients travelling abroad and receiving substandard care, which puts their lives at risk.
This is obviously a worrying trend and we need to consider how patients are making judgements and decisions and hopefully ensure people are not just taking the cheapest option.
Earlier last month, IHPN held its first Private Primary Care group meeting. It was a productive first session. We discussed its future work programme and the good work members are doing in private primary care.