As the government faces rising criticism over the NHS reform bill, David Cameron has urged hospitals to cut bureaucracy rather than making doctors or nurses redundant. The Prime Minister issued his concerns on the same day as a new health watchdog was appointed on a salary of £57,000 for a two-day week.

David Cameron said, “It was not acceptable that the ranks of NHS managers had been swelling at twice the rate of nurses, and called on trusts to make savings in back office costs.”

Mr Cameron’s statement came on the back of announcements from two London Hospitals confirming that they would be axing hundreds of posts to cut costs and save money. The redundancies announced by St George’s Healthcare Trust and Kingston Hospital Foundation Trust will see nurses and high-ranking consultants loosing their jobs. 

As with St George’s Healthcare Trust and Kingston Hospital Foundation Trust other hospitals around the UK are likely to see the number of bureaucrats increasing as the number of doctor jobs, SHO jobs and specialist registrar jobs decrease as hospitals increase back office staff at the cost of frontline clinicians in an effort to save money. 

When asked at a press conference to spell out the government’s message to health bodies that need to make £20 billion of savings in three years, Mr Cameron replied, “We have put more money into the NHS, we have taken difficult decisions elsewhere, including in welfare, so the NHS is getting a real-terms increase.”

“So, yes of course, I would urge every health authority to look at what they can do in terms of saving back-office costs, saving bureaucracy and trying to keep everything on the front line.”

“What we saw over the last few years was the number of bureaucrats growing twice as fast as the number of nurses and that’s not acceptable.”

David Cameron’s criticism of more bureaucrats being appointed over nurses and doctors was issued on the same day it was announced that Dr David Bennett, a former management consultant and policy adviser under Tony Blair, is to be appointed as the new chairman of Monitor, a health regulatory body on a salary of £57,000 for two day’s work a week. 

Dr David Bennett, who is currently Monitor’s interim chief executive, takes over as chairman as the body moves from overseeing foundation trust hospitals to becoming the economic regulator for the entire NHS under the Health and Social Care Bill. 

Dr Bennett said, “The successful implementation of this next phase of reform for health and adult social care, if agreed by Parliament, will be critical to ensuring that the sector can continue to provide affordable, high quality care, and Monitor will play a central role in making sure this is so."

Despite the government’s efforts to promote the benefits of a reformed NHS, more doctors are stepping up their opposition to the controversial legislation. At a recent regional meeting of the British Medical Association, members voted in favour of a motion calling for “total opposition” to the bill.

Labour’s shadow health secretary, John Healey, said, “The Tory-led government is losing on its big NHS reorganisation. The more people see of their plans, the less they like or trust them.”

“Most GPs don’t want the changes and four in five don’t believe patient care will improve as a result.”

“David Cameron has shown with his u-turn on the selling off of the forests that he will drop policies that are damaging and deeply unpopular. He should move now rather than later to drop his plans for the NHS, and changing course would win him widespread support.”

With the government’s criticisms of hospitals increasing the number of bureaucrats being employed against the startling announcements of more doctors and nurses losing their jobs, the major concern for doctors is that patient care will be not be improved. 

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A report by the Audit Commission has warned that patients and taxpayers may be loosing out because of poor oversight of an incentive scheme for GPs. 

The Audit Commission said, “There was a wide variation in the way primary care trusts (PCTs) across England monitored payments totalling £1 billion a year to GP practices under the Quality and Outcomes Framework (QOF).”

The report found that some PCTs “cannot be confident that payments made to GP practices are correct and justified or delivering good value, while some patients may not be getting the services they should be.”

The report warned that the issue “will need careful management if conflicts of interest are to be avoided” when PCTS are to be scrapped as part of the government’s NHS reform bill which will see GP consortia handling the bulk of the NHS budget. With GP consortia to manage previously held PCT budgets will see GPs having to decide how and where their budgets are spent, what doctor jobs and locum doctors are needed to match the level of service they are to provide given any budgetary constraints, as well as balancing the demand of patient care and services over the number of medical professions required to provide the service. 

Under the current QOF scheme which was introduced in 2004 as part of the new GPs’ contract to incentivise improvements to patient services sees GP practices receive on average £118,770 in 2009/10. 

The scheme works by GPs being rewarded according to how many points out of a maximum 1,000 they score. The areas of work that they are scored on include clinical care, organisation, patient experience and additional services. Since the scheme was implemented, GPs routinely achieve more than 90%, which is above the 75% expected as the benchmark figure when the scheme was introduced. 

The Audit Commission report focuses on the provision that allows GPs to exclude certain patients from their figures when their score is assessed. Under the scheme GPs are allowed to exclude patients that continuously miss appointments or have a terminal illness or are extremely frail. 

Currently, assessors to GP practices check ratings under the QOF scheme through visits. However, the report highlighted that in most cases, PCTs use local GPs to do the assessing, which it suggested, “may not result in rigorous regime.”

Under the current scheme, the report highlighted several areas for improvement where the scheme was deemed as failing such as some PCTs regarded the visits as a chance to help GPs maximise their income, visits to practices only if the practice requested them and another visited only 15% of the practices each year. Furthermore, there was even evidence to show that issues identified in visits were not actually followed up. 

Andy McKeon, managing director of health at the Audit Commission, said, “PCTs will soon give way to the new NHS Commissioning Board and GP consortia. Robust audit will be crucial to ensure the payments are being properly and fairly made under any incentive schemes and patients get the benefits intended.” 

Despite the government’s efforts to reassure the general public and GPs of their healthcare reform, many critics are concerned that patient care could suffer as medical jobs and doctor jobs could be lost as consortiums focus on maximising profits over patient care. 

If you are seeking NHS doctor jobs, doctor jobs, locum doctor jobs, special registrar jobs, SHO jobs or medical jobs, contact our registration team by telephone or register on line today and be part of the largest and fastest growing specialist medical recruitment agency in the UK. 

MPP Locums is an approved supplier of locum jobs to the NHS under the National Locum contract starting 1st July 2008 for the next three years and the Care Quality Commission and the NHS Buying Solutions regulate us.