Sunday, December 26, 2010

Can This Happen Here?

The UK seems to be getting the NHS into a tighter corner that it has ever been in before. The Guardian reports today the following:

A "complacent" department of health will be forced to make cuts to social care and cancer research funding to avoid an annual £10bn shortfall unless it speeds up efficiency savings across the NHS, according to a secret Whitehall report leaked to the Guardian.

The damning report warns that ministers will face an "unpalatable trade-off" between longer waiting times or a massive increase to the NHS budget unless dramatic savings are found.

It also warns that the central reform proposed by health secretary Andrew Lansley – to devolve 80% of the NHS budget to GPs – could have "patchy" results at best.

What they will try and do is to push 80% or more of the care to the GP, the local physician, who is already overburdened. And in the UK the GP is for the most part a gatekeeper. The specialists are the ones who all too often do the heavy lifting. The GP is your day to day local doc, and since the inception of the NHS the GP is noting more than a symptom taker and stopper of costs escalation.

The specifics include:

The NHS cannot afford to spend up to £200m a year on supporting research by big medical charities such as Cancer Research UK.

• The government should scrap the "very bad policy" of employing all doctors when they graduate.

 Cancer Research is the equivalent somewhat to the NCI which is orders of magnitude greater. Cancer Research is often more clinical and less fundamental. The Government employs almost all docs and that is the way they control costs, and yet again the education costs are low to nil, so low pay but low costs.

Yet this whole process may be a harbinger of things to come in the US. The pressure on new physicians is extreme given the costs and debt burden and then again the reimbursements will be de minimis. The problem has not been the physician it has been the hospital. This is truly worth watching.