NHS Reforms: How Do They Measure Up With Other Systems?

Pharma IQ

UK health secretary Andrew Lansley recently announced radical reforms to the country's National Health Service (NHS) aimed at both cutting costs and improving patient care – which some might consider to be two contradictory claims.

The Health and Social Care Bill 2011 could essentially be said to be reducing layers and bureaucracy in the NHS through "bring commissioning closer to patients by giving responsibility to GP-led groups", "streamlining arms length bodies" and "supporting all trusts to become foundation trusts and establishing independent regulation."

Concentrating on the first point, the bill puts greater responsibility in the hands of GPs by allowing them to make decisions about which services to provide based on the needs of their local patients, according to the government.


Reactions to the proposals, which were hailed by the UK government as creating a "more patient centric NHS", have been mixed.

Dr. Michael Dixon, chairman of the NHS Alliance, a body independent of both government and political parties, said: "Many GPs have been fighting for these reforms for a number of years and after a few false starts, it is good to see the government is listening and taking the appropriate measures."

Dr. Clare Gerada, from the Royal College of General Practitioners, said "it makes sense" for the power to commission services to be placed with GPs, however she expressed concerns surrounding the government was planning on implementing the proposals. Dr. Gerada said efforts must be made to"guard against fragmentation and unnecessary duplication" and any subsequent negative patient outcomes."

The British Medical Association, meanwhile, expressed similar concerns about fragmentation, and also raised the issue of price competition which may arise from "forcing commissioners of care to tender contracts to any willing provider."


While there are those concerned about the state of the NHS in the UK, internationally there are those who believe the right steps are being taken.

In Canada the debate is currently raging about the country's universal healthcare system, which according to research by McCleans magazine now ranks bottom in the world, based on the time it takes patients to get treatment and the quality of care they receive.

Ken McQueen from the magazine said in comparison with the UK, the Canadian system, doesn't "fare that well."

Key issues for reform centre around the delivery of primary care services, which are offered by family physicians and general practitioners. Calls are now being made for these professionals to form primary health teams, which are able to provide more comprehensive care and a better coordinated service.

The separated nature of the territories means each is implementing its own series of reforms, although the creation of accountable teams providing healthcare services is a central theme. The changes are being supported by the Primary Healthcare Transfer Fund.

Robin Osborn, vice-president and director of The Commonwealth Fund's international programme, told the Montreal Gazette that the reforms being proposed in the UK were positive in that they gave more control to doctors, but again expressed concerns it could adversely damage the service.

"The UK is on many levels a real success story," she said


The subject of making smaller, more localised groups accountable for healthcare was also raised in reforms suggested by Australia's former prime minister Kevin Rudd.

Under the plans, Rudd suggested four hospitals should group together into trusts and take on responsibility for care in their regions, as they are likely to have better localised knowledge.

Stephen Leeder, director of the Menzies Centre for Health Policy at the University of Sydney, writing in the Australian, suggested in fact these networks should include GPs and other care providers to offer a greater picture of the situation.

"Network health boards should be composed with great care, preferably being depoliticised, and avoiding deeply vested and conflicting interests," he added.

Canada and Australia's healthcare systems do differ from the NHS in many ways, one of which being that they are less well established. However, the proposed reforms in all three systems suggest providing care for local populations through groups led by local GPs is an emerging trend, which many believe if managed properly could improve patient care.