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The New NHS Health Economy-A personal view from the coalface

The biggest change occurred during the last Conservative government when the purchaser and provider roles in the NHS were separated. Fundholding was introduced whereby GP practices were given budgets to purchase care for their patients and with GP’s acting on behalf of their patients did appear to be positively moulding Health Services for the benefit of patients. This system was overnight dismantled by the incoming Labour government whose initial idea was to disband Health Authorities and create Primary Care Boards which were much smaller units of Healthcare with ‘locally sensitive’ purchasing; our local PCB covered Watford and Three Rivers and was run largely by elected GP’s acting on behalf of all local practices. The administrative structure was changed to Primary Care Trusts with the remit of again being locally sensitive to healthcare needs. This was deemed to be too expensive and after various political manoeuvrings within Hertfordshire, the Primary Care Trust unit was changed to encompass half the county with several structures encompassing the whole county, hence pretty much going back to the Health Authority model.

The purchaser and provider split has been further developed with local commissioning units purchasing on behalf of the local practices. In the Watford area this is called ‘Watcom’ which is increasing independently of PCT control and is making purchasing decisions on behalf of the local practices but with no representation from this practice, the decisions made may not be sensitive to local patients particular needs.

Providers of care used to be almost always Hospital Trusts but this has now been changed to now include ‘any willing provider’. This means that for any given service, say for dermatology there may several accredited providers who may tout their particular services to local GP’s who primarily make the referrals. Amongst these new providers there are increasing numbers of private providers, often the large multi-nationals who want to move into this potentially lucrative area and can undercut others as a loss leader to get this new area of business. The other main sort of Provider group moving into the market is run by GP’s or have GP input. As it may be the same GP’s who also are referring into these services this may influence referral decisions to favour these GP run services.

All of this is taking business away from the Hospital Trusts and often are the easy pickings, thus leaving the Trusts with the more complex often less lucrative work. This is very likely to make these Trusts effectively bankrupt if they do not take draconian measures and often leads to amalgamations or even closures. West Herts Acute Hospitals Trust is starting to go through this pain as some services are moving from site to site such as casualty to make economies and they are even taking such drastic steps as demolishing building to reduce crown charges. Further afield High Wycombe has had to close its casualty and move this to Aylesbury.

The Government is further penalising Trusts by imposing a fixed Tariff price which Trusts have to charge but other providers may not. The Government has imposed these rules on the Health Service without any real consultation or any pilots with the net result is that it is anybody’s guess as to where this will all end up. These imposed changes may just be the result of Whitehall minions having to create mischief to justify their existence or could it be simply due to political dogma? A possible ulterior motive could be to eventually privatise the NHS through the back door. This would certainly save the Government a lot of money but then runs the risk of an USA style health service where there are an estimated 50,000 unnecessary deaths per year due to lack of medical care because of lack of health insurance.

I certainly do not know what is driving these changes but from my experience over the last twenty years know that it could be all change again within two years if there is a change in Government. These changes are having an effect on the NHS staff. Hospital consultants used to more or less have a job for life with a particular Hospital. Now if the contract moves which it could do on a yearly basis they will have to move with the work or risk losing their jobs. Consultants are also being laid off in a bid to save money, often in specialities which do not influence waiting lists such as Psychiatry and where lack of care is not easily measured. This is leading to a diminution in care often of the most vulnerable in our society, but is largely going unreported.

Some General Practice areas have also been put out to tender with the private sector often winning the bid against an already established proven high quality service. Why this is the case is not clear but is likely to be due to political influence. The latest move politically is to create the so called ‘polyclinic’ which put other services into the same building as GP services. These are being set up in all PCT areas and effectively act as local competition for the existing practices. This is likely to make the existing practices unviable and may thus force them to close.It may be that the recruiting for these new polyclinics may be from the EU as a cost cutting exercise and further undermine the existing services.

All of this may progress but I am not sure!

Gade Gazette December 06

Seasons greetings to all our patients

We hope you will enjoy a happy and peaceful Christmas season. If you are travelling abroad during Christmas and the New year, please make sure your vaccinations are up to date. If you are unsure, please collect a travel form from the surgery so that our Practice Nurses can assess your travel needs. We are unable to make any appointments for travel vaccines less than 7 days before departure and must stress that some vaccinations do not become fully effective until 14 days after administration.

Christmas Opening Times

The surgery will be closed on the following dates
  • Saturday 23rd December
  • Sunday 24th December
  • Monday 25th December
  • Tuesday 26th December
  • Monday 1st January 2007
In an emergency please telephone 01923 775291

Repeat Prescriptions

Please remember, in order for your repeat prescription to be ready by 22nd December when the surgery closes, your request needs to be with us no later than Wednesday 20th December.

Pharmacy Rota

We are still waiting for details of the duty rota for pharmacists over the holiday period. Please check with the surgery nearer the time for details. Details will also be published in the local press.

Flu vaccines – appointments still available

Although our flu clinics got off to a late start (the result of delays in the arrival of vaccines) we have been fortunate in having a mild autumn so that a major outbreak of flu-type viruses has yet to affect us. If you are eligible for vaccination but haven’t already done so please do make an appointment for flu and, if appropriate, immunization against pneumonia.

Gade Web Site –

We are pleased to announce that, thanks to the efforts of Dr Tim Airey, the practice now has its own web page which you can find at: This is being developed as one of the ways in which we hope to improve communications with our patients and to enhance the service we provide. Over the coming months we plan to develop this further to include patient health information, links to other health websites and an up to date bulletin board so that we can keep you informed of significant changes and health advice as it becomes available. This will also play a key part in the development of the practice contingency plan enabling us to cope effectively in the event of a major incident. Linked to the new web site we are also introducing a facility for patients to order repeat prescriptions by email. This is a development which we are sure will prove popular, particularly to working patients and those for whom email provides an essential link with the outside world. If you visit the website, you can copy and paste the list of information we will require in order to process your request. This will save you time in typing your email and will ensure that we have enough detail to process your request safely and promptly. Email requests will be available for collection within 48 hours of receipt. The email address for repeat prescriptions is: To order repeat prescriptions by email, please include:
  • Patient Surname
  • Patient Forename
  • 1st line of your address
  • Date of Birth or NHS Number
  • Contact Telephone Number
  • Email address
  • Whether you wish to collect your prescription from Chorleywood or Rickmansworth
Please note that this mailbox is for prescription requests only – we are unable to deal with or respond to any other enquiries

CCTV at Gade House

We have recently installed CCTV monitoring equipment in the 1st Floor Waiting room and other public areas at the Gade House surgery. We must stress that this has been done solely to improve the safety and security of patients and practice staff in areas of the building not monitored by practice staff. Patients may rest assured that the system complies with the requirements of the Data Protection Act 1998

Missed Appointments

Approximately 120 appointments (3%) per month are ‘Did Not Attend’ (DNA), ie the patient does not turn up for the appointment and does not contact the surgery in advance to cancel/change appointment. The effect of these are:
  • An increase in the waiting time for appointments
  • Frustration for both staff and patients
  • A waste of resources
Because of the problems this causes, the partners have adopted the following policy on missed appointments: If a patient DNA’s an appointment THREE TIMES then they will be sent a letter and a copy of the notice explaining the policy. If they DNA a further appointment than a review of the case will be done by the Practice Manager and one of the Partners to establish whether there are any specific reasons (social or clinical) why the patient should not be removed, with an outcome of either:
  1. The patient will be invited in to meet with the Practice Manager to explain any difficulties they may have with keeping appointments.
  2. They will be sent a letter informing them that in accordance with the practice policy, it has now been requested for them to be removed as a patient from the practice and they should find an alternative doctor.

Teenage Drop-in Clinic

We are pleased to confirm that we still offer a confidential service for teenage patients. The clinic runs from 4.00 to 4.30pm every Tuesday. No appointment necessary, just drop in for a chat about contraception, sexual health or general healthcare advice.

New Staff At Gade

We welcome several new members of staff to the Gade team. Joining the nurses, Mina Chavda and Gill Lowen are already well established having joined us with a wealth of valuable experience. They are currently integrating into the team under the guidance of Lead Nurse, Gail Johnson. New to our reception team, we are also pleased to welcome Tracey Maw who again joins us with experience of working within general practice. We wish them all every success.

Health Visitors

Patients with young children may have been aware of the difficulties being faced by members of the health visiting team as a result of changes to their service. However, January will see the welcome return from maternity leave of Health Visitor, Emma Kay, who returns to work after the birth of her son Archie. Our congratulations to Emma and a warm welcome back to Chorleywood branch surgery.

New Years Resolutions – Stop Smoking?

If you’re thinking of giving up smoking in the New Year, your chances of success are considerably improved if you have the proper support from the outset. Just make an appointment with our practice nurses who will give you all the encouragement and help you need to kick the habit. Alternatively, all our local pharmacies provide a stop smoking service and will be only too pleased to help.


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