The Department of Health funded UK GP Patient Survey 2009-10 featured more than 5.5 million detailed questionnaires being sent out to NHS GP patients across England of which 2.17 million were returned. For the city of Sheffield a total of 65,339 questionnaires were sent out to the patients of Sheffield's 92 GP surgeries of which 27,380 were returned from which detailed results were compiled as listed in the table at the end of this article for the overall level of satisfaction at the quality of health care received for all of Sheffield's GP surgeries.

Of Sheffield's 92 GP surgeries, 24 or 26% managed to achieve a rating of 95% or higher, which given the importance of health care should be the minimum goal for ALL GP surgeries. Next 43 (46%) of Sheffield GP surgeries managed to attain a patient satisfaction level of 90-94% of their patients, 19 (20%) between 85% and 89%, followed by 6 GP surgeries scraping the bottom of the barrel, notably Darnall Community Health coming in at an abysmally poor bottom rank of just 68%.

Sheffield's Bottom 5 GP Surgeries

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	Level of Satisfaction Q1-Q4
HAROLD STREET MEDICAL CENTRE	83%
STONECROFT MEDICAL CENTRE	80%
HIGHGATE  SURGERY	76%
DARNALL HEALTH CENTRE (MEHROTRA)	73%
DARNALL COMMUNITY HEALTH	68%

 

Darnall Community Health continued to feature at or near the bottom of Sheffield's 92 GP surgeries. Sheffield PCT had already identified a year earlier the lack of performance and publicised a solution during mid 2009 for a new £5.5 million medical centre to be built under the NHS Local Improvement Finance Trust (LIFT) Development Scheme which is a private / public partnership that is tasked with dragging the NHS front line services into the 21st century by means of construction of new integrated one stop shop Super Surgeries premises along the lines of the 2009 unveiling of the City Centre GP Walk in Centre (Sheffield GP Super Surgery Polyclinic NHS Healthcare Centre). The plan was for building work to commence early 2010 and for the centre to open by early 2011.

Community 1st Sheffield (C1S) - 17th August 2009

The exciting plans for the proposed new Darnall Health Centre were unveiled in the existing surgery this week. Representatives from NHS Sheffield and Community 1st Sheffield were also on hand to speak to patients and local residents about the scheme and answer any questions.

The proposed new premises, which will be located on Main Road, Darnall, will replace the existing Darnall Community Health services in Darnall Road and York Road which have outgrown their premises as patient list sizes have grown.

The planned new state-of-the-art facility will house facilities for minor procedures, counselling and therapy services, physiotherapy, district nursing and health visiting, and Darnall well being service as well as GPs in a brand new purpose-built development.

The proposals are due to be submitted for planning by the end of August 2009 and, subject to the planning approval consent, it is anticipated that construction work will commence on the new premises in early 2010 with the building open to the public in early 2011.

New Darnall Medical Centre Status - June 2010

Unfortunately as the June 2010 article indicated and illustrated by the below photo, that the proposed site for the centre remained untouched as commencement of building work was still awaiting final signing off from the Strategic Health Authority (NHS Yorkshire & the Humber) which expected to take place during September 2010, which means that the earliest construction could commence was during late 2010 and therefore the earliest that the centre could be expected to be completed by was Mid 2011.

New Darnall Medical Centre Status - Feb 2011

Now more than 8 months on from the last update of June 2010 and on the originally planned completion and opening date for the new centre, the below photo clearly illustrates that the building site still remains untouched.

Conclusion

Probability now highly favours that the new Darnall Medical Centre is NOT going to be built as it is highly likely that the soon to be scrapped Sheffield PCT no longer has the budget to do so, instead the proposed centre plans can be deemed to have been permanently moth balled or scrapped.

This is indicative of two factors -

a. that the Coalition governments promise of raising NHS spending in real terms by 2% per annum belies the fact that the NHS is so unproductive as an institution that just to stand still the NHS requires an annual increase of 8% per annum, which effectively means the NHS budget in operational real terms is being cut by 3% per annum.

b. that projects planned under the Labour government right across the NHS have been suspended or scrapped as the NHS gears itself up to cut costs in an attempt to bring some modicum of value for money and productivity amidst an atmosphere of economic austerity as the Coalition government attempts to bridge the huge £150 billion budget deficit between that which the government earns in revenues and spends on services.

Therefore the Coalition government is not prepared to throw millions of pounds of tax payers money at bottom ranking GP surgeries, which means solutions will have to be found in existing surgery staff being forced by the developing GP Consortia's to hand over the keys to a more organised private health care providers such as Onemedical.

Options for Patients

The patients of Sheffield's and other cities bottom ranking GP surgeries have the following possible options:

1. Stay with current GP surgery..

2. Attempt to move to another better ranking nearby GP surgery (see table below), though as there is no competition for patients then it is highly likely that patients will be prevented from doing so.

3. Pay for Private GP services - Though now the patient is being forced to pay TWICE for healthcare, once through taxes and then again privately.

4. Obtain a copy of your full medical records and attempt self diagnoses and treatment, yes it is completely outrageous that patients should be forced to diagnose and treat themselves, but that is what happens when you have a healthcare monopoly that has long since forgotten why it was created in the first place. In this respect GP surgeries 'should' comply with the data protection act by on request sending you a copy of your medical records within 42 days, though that does not mean that a bottom ranking GP surgery will comply with this deadline which is indicative of its general level of competency.

Coalition Government NHS GP Consortia's Reforms Disaster

Real improvement in patient care requires a breaking of the NHS monopoly from GP's to hospitals that contributes towards the worst health care service in western Europe. Unfortunately the Coalition Governments NHS reforms to scrap ALL NHS Primary Care Trusts and replaced by competing GP Consortia's to directly manage the £85 billion budget for patient treatment commissioning, looks set to be heading for a complete disaster on the scale of the last Labour governments GP Contracts disaster, as GP Consortia's are being formed across the land on the basis of avoiding competition with one another.

The current system of patient health treatment commissioning is via the 152 Primary Care Trusts that manage an annual budget of approx £100 billion which the government aims to replace with approx 600 GP consortia's that Britain's 35,000 GP's are in the process of joining so as to have the responsibility for buying healthcare for their patients. The intention was for the new system to introduce market forces into the NHS with the result that failing hospitals would be allowed to go bust and similarly failing GP surgeries would lose their patients to better performing GP's / Consortia's.

Breaking the NHS Monopoly

There is no real competition in the current NHS system which demands reforms as the monopoly in healthcare operates right from the GP surgeries straight into hospitals to the detriment of patient health and tax payer funds, as Britain despite doubling spending in real terms during the Labour years still trails at the bottom of the European health leagues, even when compared with Eastern European health services that spend less than 1/3rd that which the UK spends on the NHS per capita. No Monopoly, whether private or state has ever provided competent deliver of services, which is why the Coalition government planned to reform the out of control NHS Healthcare state monopoly.

Unfortunately the coalition reforms appear to be on target to replicate the disaster of Labours 2002-2003 GP Contracts, as GP consortia's across Britain are forming non competing area bound Consortia's as illustrated by the example of City of Sheffield, as virtually all of Sheffield's 92 NHS GP Practices have signed up with one of of 4 geographically located GP Consortia's in advance of the implementation of the Coalition Governments NHS reforms.

• Central Sheffield Consortium
• HASC ( Hallam & South Consortium)
• North Sheffield Consortium for Health
• Sheffield West Consortium

The flaw in the organisation of geographically focused consortia's is to continue the current system of NON competing GP Surgeries for patients into non competing GP Consortia's which means that the governments planned pro market reforms will fail and patients could end up with even worse health services as GP's will be wielding far greater power within their geographic constructed Consortia's then they were able to wield under the city wide Primary Care Trusts, therefore no competition in GP services will exist and the reforms are destined to fail, just as badly as Labours 2002-2003 GP contracts failed, which instead of improving health care delivery, the GP contracts resulted in sending annual GP pay rises soaring into the stratosphere, culminating in pay rises of more than 30% per annum to stand at twice where GP Pay should be in terms of average earnings rises, whilst at the same time GP's cut back on hours worked and services such as out of hours services, a double loss for the patients and tax payers.

Requirement for Competing GP Consortia's

Having non competing Geographic GP consortia's would be a recipe for disaster, as delegating powers to GP's without mechanisms for competition between GP surgeries for patients ensures that over time neighbouring consortia will seek to merge with one another thus reverting back to PCT sized consortia's, whilst these Consortia's will be virtually totally unaccountable to their patients, with total control now in the hands of city-wide non competing GP Consortia's, which would be a perfect monopoly solution for GP's that would be significantly worse than the current PCT system, which at least enables some independent scrutiny of GP surgeries performance to take place, rather than GP's being put in charged of monitoring themselves, with only lip service additional monitoring by local authorities.

Therefore for the Coalition Governments reforms not to fail then city wide consortia's should be created with the aim that there are at least 2 and preferably 3 competing GP consortia's per geographic areas. Thus in Sheffield's example, all four of newly established GP consortia's should be disbanded in favour of the creation of city wide consortia's that will enable patients to easily switch between the better and poorer performing GP's / Consortia's as the current system ensures that Sheffield's NHS GP Post Code lottery will just be further magnified due to lack of sharing of best practice which will become more concentrated in the better performing GP surgeries as the below post code lottery map illustrates (Sheffield NHS GP Post Code Lottery Map, The Best and Worst Ranked Surgeries )

NHS Privatisation Solution

Britains population has been conditioned over the decades to resist calls for the privatisation of the NHS. However, contrary to what the population believes GP's have always been Independant PRIVATE contractors to the NHS WITHOUT COMPETITION. GP surgeries are basically businesses for profit that operate with local monopoly powers over a captured patient population. The British population would not put up with any other monopoly but have been falsely led to believe that their GP is employed by the NHS when in fact is a private contractor. This fact completely defeats the argument put forward by the BMA which is the propaganda arm of Britains 35,000 GP's against private companies being allowed to deliver NHS services, which is what one would expect from those that seek to preserve their monopoly that allows outrageous profits to be generated at tax payer extent whilst patients are treated as ATM cards to swipe in and out of doorways.

Therefore coalition plans to hand over much as £85 billion per annum to PRIVATE GP Businesses that do not compete against one another would be a total disaster. The only answer to the crisis in the lack of productivity in the health services is for competition between GP surgeries and NHS hospitals which ultimately means FULL privatisation, as the existing system of no real competition means that lack of performance is rewarded with more resources in the face of inability to deliver whilst those that excel are punished with less resources so as to pull all services down towards the under performing mean.

The only way excellence can be rewarded and duplicated is if competition drives out of business the less competent GP surgeries as they lose their patients and resources to the better run GP surgeries which can only happen in a market orientated system of healthcare delivery, where patients would in effect be handed NHS heath credit cards to enable them to buy healthcare at ANY health facility whether NHS run or private.

Given the actual performance of the NHS, I would imagine that closing 15% of the worst performing NHS Hospitals and GP Surgeries would result in IMPROVED life expectancy for Brit's as well as contribute a £18 billion of annual savings to help bring the unsustainable £150 billion annual budget deficit under control rather than the existing Coalition policy of INCREASING the NHS budget by more than £20 billion.

Without mechanisms to drive the less competent hospitals and GP's out of business, then Britain's patients will continue to receive what amounts to a third world health service whilst paying a first world price.

The NHS Health Insurance / Credit Card

The NHS post code lottery which excludes millions from the best health care on offer can only be ended if there is real patient choice, not only for GP's but also hospitals and other health institutions right across the country where treatment is sought which requires real reform of the whole NHS health care system from diagnosis to treatment of all patients .

An important element would be to place the power to purchase healthcare in the hands of the patients by means of an NHS Health Card system, that enables patients to purchase health services from any GP practice or hospital regardless of whether it falls under the NHS umbrella or is fully private, with personal medical records encrypted onto the cards smart chips. Both patients and health practitioners would be fully aware of the financial transaction involved in the purchase of the health service, which is set against the current system where patients can be made to feel that they are an inconvenience so are easily put off by the practiced dismissive attitude of most GP's during the initial consultations, which means the medical condition of patients reaches a far more serious state and thus proves far more costly for the NHS to eventually treat.

The mechanism for the operation of the health cards could be by means of either an insurance or a credit based system.

Insurance System - An insurance system such as that which is successfully operated in Germany, where workers pay a premium as a percentage of their wages (average 14%, employer and employee paying half) into one of over 300 statutory state funds, that then cover the costs of healthcare. Patients can choose between insurance funds on the basis of premiums charged so competition acts to keep premiums competitively priced. Similarly patients are fully aware of their premium payments and cost of services thus demand a competent health service delivery. Those that are not working have their premiums paid for by the state. Additionally those with salaries above statutory limits can opt out of the state system and buy private health insurance.

Credit System - Patients would have a choice of covered core treatments for illnesses or injuries, where they would have the option of paying to top up treatments with their own money depending on the institution that they seek to purchase treatment from, or for other extra's such as IVF etc. This would have the effect of reducing the cost of the NHS whilst introducing greater efficiency into the NHS as the majority of patients would only choose those health service institutions that are ranked as delivering a good service. The NHS Health credit card would revolutionise the way healthcare is delivered in the UK, much as supermarkets revolutionised food delivery and choice during the 1980's, as heath supermarkets would spring up all across the country that would maximise efficiency and standardise quality of service delivery as they competed to offer a wider range of health services than anything a bureaucratic top down health care system could ever hope to provide.

The health care credit card system could be further enhanced by workers directly contributing to their health care plans that they can claim upon to purchase 'extra' services at a later date, much as workers today contribute into private pension schemes.

The impact of either an Insurance or Credit based system would be to greatly REDUCE the cost to taxpayers whilst at the same time delivering better health services as the focus would be on prevention to reduce costs, therefore a win, win outcome for the people of Britain as opposed the current system of an out of control unproductive £120 billion National Health Service that attempts to mask failure to deliver with phony statistics and propaganda of a "free for all service" that fails to match real patient experience.

Sheffield UK GP Patient Results 2009-10

The following table lists all 92 Sheffield GP surgeries ranked in order of patient overall satisfaction of care received. The results for the year 2010-11 will be released during summer 2011.

Data Source - http://results.gp-patient.co.uk/report/main.aspx

By Nadeem Walayat

http://www.walayatfamily.com

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