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Interview ‘It’s only a matter of time before someone gets hurt’

Ruth Hunt talks to GP Dr ANDY KOVAC about how NHS fragmentation and the government’s obsession with gimmicks are having a devastating impact on patient care

TORY meddling in the NHS has turned the much-loved national treasure into an acronym-spouting, constantly fracturing, overly bureaucratic, confusing mess, which is prone to systemic failures.

For Dr Andy Kovach* who is a practising GP, the top-down reorganisation of the NHS in 2012 by the then coalition government is a big part of the problem: “Since the controversial Health and Social Care Act 2012, the NHS in England has now become a bewildering and disjointed network of public, semi-public, semi-private, private and third-sector providers,” he says.

The main thrust of the Act was to abolish primary care trusts and strategic health authorities and instead transfer responsibility and funds away from the government on to clinical commissioning groups which have to judge which provider would receive the contract for a service. 

It brazenly opened the front door of the NHS for the first time in 64 years to private operators and fierce competitive tendering, which has left the provision of health and social care fragmented, patchy and forever in flux.

“From my desk as a GP, referrals which ought to be simple are increasingly confusing and frustrating as the organisations commissioned to provide a particular service must be retendered periodically and can change every few years. 

“When doctors are confused by how the system works, how are patients meant to navigate it when things go wrong?  

“Only those with the time, resources and education are able to challenge and appeal the system. The rest are abandoned by groups and organisations they’ve never heard of.

“To me, the system works best when transparency and honesty are strongest, but many organisations are trying to protect their own interests by exaggerating their own successes and downplaying their failings before bidding for the next contract. 

“This means clinicians — and the hordes of legal advisers — who are spending time in meetings, rather than with their patients, are trying to work out who should win the next contract with incomplete or inaccurate data. 

“As the 2012 Act means decisions about health and care provision are pushed onto those local clinicians, and other members of the commissioning body, they’re the ones who face the brunt of public anger when any unpopular decisions have to be made. Meanwhile, the real culprits keep a safe distance away.”

It was argued this radical restructuring of the NHS would give GPs more control, but Kovach says it takes up a huge amount of his time. 

Some patients can have a patchwork of three or more different providers, meaning continuity of care is lost, with no one organisation having an overall role in monitoring that patient.  

The care patients receive is also changeable, both in terms of provider and remit. This means for a significant part of his day Kovach is trying to keep track of what services are still running or no longer exist and what the public, private or third sector agencies are doing that month.  

With so many different organisations involved, Kovach says that at times it’s difficult to keep up with what actually is or isn’t a GP’s remit.

“There’s often a feeling that anything not covered elsewhere must be our job, even if it’s something we’re not trained, funded or insured to do. Even so, many of the ‘solutions’ suggested, require GPs to work outside of their normal remits and the insurance and indemnity organisations are not always ready to cover us for working in untried and untested ways. 

“This could be overseeing other professionals such as paramedics, physicians’ assistants and nurse practitioners, using new technologies like video consults or emails, or algorithms to direct people to, hopefully, the most appropriate care. This means that, if something goes wrong, we’re on our own.”

The third Health Secretary since 2012, Matt Hancock, has said he wants the NHS to be a world leader in implementing new technologies. 

Kovach feels that such significant untested new developments in technology should undergo a standardised and publicised way of trialling, comparing and establishing their safety, like we do with new drugs or surgical techniques. 

However, he strongly suspects that instead there will be a rush to grab every new silicon gimmick that comes along.

He says: “As such, it’s only a matter of time before someone gets hurt. When I phone someone, I know I can’t examine them, so, if I’m concerned, I bring them in. 

“The point of video calling is to give the impression that you have seen someone, when you haven’t. I can’t imagine a situation where it won’t be safer to see someone in person.

“When someone does get hurt, is it going to be seen as an unfortunate consequence of a struggling system, with a focus on reducing the chances of it happening again? Of course not! It’s going to be blamed entirely on whoever agreed to video call instead of seeing the patient face to face.  

“We only need to look at the case of Bawa-Garba. The message from her case should have been, this hospital does not have appropriate systems in place for dealing with an overload of very sick children and a failure in the IT system.  

“The eventual outcome was that one doctor and one nurse were convicted of gross negligence and manslaughter. I don’t know many doctors who, if honest, couldn’t say that it could easily have been them, but doing your best in a difficult environment is no defence. 

“Rather than acknowledging that these experiments have exposed the flaws and abject failure of market-driven healthcare to provide a service that is fair, functional and fit for the future, we are left with a complicated NHS which is vulnerable to all sorts of systemic failings and a government that has actively worked to make itself less accountable for its own mess.

“We were promised that staff working in the NHS would be given more control,” says Kovach.

“Instead, it feels like we’ve been handed the axe.”

Andy Kovach is not the interviewee’s real name. Ruth Hunt is a freelance journalist and author.

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