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Last Updated: Friday, 16 September 2005, 22:48 GMT 23:48 UK
Thinking the unthinkable for the NHS
By Nick Triggle
BBC News health reporter

Blue sky
The public is being asked to do some blue-sky thinking about NHS services
Hospitals may get a large share of the attention given to NHS care, but most people access the health service through primary and community care.

And plans to reform this sector are set to have a huge impact.

Nine out of 10 patients who come into contact with the NHS use primary care services such as GPs, sexual health clinics, social services and pharmacies.

And after years of hospitals dominating, community services are now coming under the microscope with an ongoing public consultation on the care available ahead of a White Paper early next year.

In a series of US-style mass town hall meetings, the public are being asked to come up with ideas on how they want to see services run.


This approach means a radical overhaul of services could be in the pipeline.

The first public meeting took place in Gateshead last week, with others planned for Plymouth, Leicester and London, after which the findings will be fed into a national event in Birmingham.

Campaigners say the consultation, based on a US concept called America Speaks, offers the public an opportunity to reshape community care with some blue-sky thinking.

GPs - Patients may be able to register at a GP close to home, work or family with their family doctors providing an extended range of services such as diabetes clinics
Social services - Social workers could be working alongside GPs, allowing both health and care needs to be addressed at "super surgeries"
Sexual and mental health clinics - Attempts to bring such facilities into the mainstream could see them set up in libraries and leisure centres
Pharmacies - As GPs take on more specialised services, pharmacists are likely to take on more responsibility, including prescribing and blood pressure screening

The first area for reform is GPs. For years family doctors have acted as gatekeepers for the NHS, making referrals to hospital or writing prescriptions.

But that role is changing. Reforms already underway give GPs more power to develop specialised services such as diabetes clinics and minor injury units.

A new pharmacy contract has encouraged chemists to get involved in smoking cessation clinics and blood pressure testing as well as prescribing.

"The gatekeeper role is going to be much reduced and the public will be discussing what they expect of their GPs in the future," says Joe Farrington-Douglas, health and social care researcher at the Institute for Public Policy Research.

"It may be that there will be more self-referrals to physios and chiropodists.

"In turn, that relieves the burden on the doctor to develop other, more specialised, services."

There are also likely to be discussions about access to GPs.

The most radical proposals mentioned in recent months include scrapping patient lists - allowing the public to use as many GPs in as many areas as they like, instead of the current system whereby patients can register with doctors only if they live in the catchment area.

'Third way

"I don't think it will go so far," says Mr Farrington-Douglas.

"It seems likely there will be change from the current situation, but it is more likely a third way will be reached such as allowing patients to register close to work or elsewhere that is convenient."

Dr Michael Dixon, a GP and chairman of the NHS Alliance, which represents primary care professionals, agreed a change was in the air.

"You could have a system whereby patients can register with two doctors, with one remaining in overall control, but these suggestions are controversial for GPs."

Dr Dixon said he could see a type of two-tier system developing, with older patients wanting continuity of care, and younger ones valuing fast access.

GP at work
Nine out of 10 NHS patients are seen in primary care settings

"Maybe you could have an acute care team manned by nurses, paramedics and GPs to see people quickly, and then a more traditional advanced booking system where you get a regular GP."

Other measures could include the introduction of the private sector and co-operatives, involving the public and medical profession, in providing GP care for NHS patients.

However, it is unlikely this will be done on the scale of hospital operations with nearly one in 10 NHS operations carried out by private providers.

But it will not just be GP services which undergo an overhaul. Social services have been included in the remit, prompting suggestions that social workers could work alongside GPs in "super surgeries".

Meals-on-wheels and home care services may also become part of the GP referral system.

Alcohol abuse

Mr Farrington-Douglas said: "People do not look at health and social services as distinctively different."

And there could also be a sea-change in the way "Cinderella" services, such as mental and sexual health, are provided.

Andy Bell, of the Sainsbury Centre for Mental Health, said: "People with severe mental health issues often have dual problems, such as alcohol abuse and depression. Services need to make sure they meet all these needs."

Mr Bell is also a supporter of having health centres in leisure centres and libraries.

Similar proposals have been put forward for sexual health, to give everyone access to clinics within 48 hours by 2008.

Sexual health charity Brook said: "We need to make it as easy as possible for people to use clinics, and the other advantage is that having them in everyday settings helps to de-stigmatise."

Access, it seems, is the buzz word. Simon Williams, director of policy at the Patients Association, said in many respects the White Paper will be judged on how it improves it.

"Services need to be based around the needs of patients, and not staff as it so often seems.

"The government wants to introduce choice, but if someone cannot use local services, there is no choice. Access is what it is all about."

US-style forums 'to reform NHS'
14 Sep 05 |  Health

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