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Opinion thread: Because people in the UK treat the nhs like a religion and refuse to have a grown up, sensible discussion on healthcare reform. I believe we are getting a back door american style privatisation. Which is further down the path than people think
If we had open honest discussion and a willingness to find the best solution It would be a lot harder to pull this off. Here is why I think we will be getting an inferior version to an already nightmarish American system:
1. It will not be a fee for service system but will be tendering of contracts to provide general services. This will mean the staff aren’t as well paid as the US but also there will be less incentive to provide excellent service. The incentive will be providing the service as
Cheaply as possible and to maximise the profit for the awarded contract. This impacts quality, staff morale, recruitment & retention etc but increases profit for the buyers of the service currently government soon to be insurance companies
2. A higher level of professional dilution in the system. The government are currently trying to dilute care to the lowest grade (and cheapest person) possible. This is why they’re pushing the allied healthcare professional thing to do the work of doctors. Ur getting some
Of this in America but culturally they wouldn’t put up with the level of it you’re getting here. Because of those cultural norms they will be able to push that to its limit over here. Decreasing quality for the people. Increasing profit for the corps
3. The gatekeeper model in the uk. GPs play a gatekeeper role to secondary care here. In an American system insurers are looking for any reason to deny care to the expensive customers (patients who really need help) in America u don’t have that barrier. U can bypass it and
See whoever you like. I feel over here they will try and keep a lot of that gatekeeper aspect as an extra layer to be able to deny people care. The primary care staff will likely be financially incentivised to do so.
4. Quality of clinicians/incentive. The biggest pet peeve of the money makers in the american healthcare system is how much the healthcare professionals earn. They will learn from this mistake and try their hardest to drive down earnings. Either by trying to make everyone>
Employees and keep them out of ownership positions (ironically the only reason GP is the last area where u can make good money within the nhs structure) or they will just really drive down remuneration. One thing people forget about America when they moan about it
It’s they have a lot of superb, innovative and top end doctors. A big part of that is they have a massive incentive outside just their professional pride to be incredible at their job as it impacts their bottom line. In the uk outside your professional pride/morality you have no
Incentive to be truly great at what u do. Bar GP where it’s about the business side. Clinically provided ur mostly competent you will take home the same as the next person. So why bother putting in the extra hours that separate mediocre from good, good from great? A lot won’t
In a nutshell the new contact making these PCN’s is the next step and has primed us for the American model. The next step is then erode the funding from the core contract and divert it to PCN’s. Once the majority funding is out of the hands of general practice. We are done 
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If people were sensible and open to adopting one of the European models which is far better suited to the dynamics of the uk population and also produces better results l. We wouldnt be in this mess. I just hope everyone has savings and looks after them self because itl get long