Surgical colleagues are leaving NHS management in droves and establishing groups of independent contractors to provide the operations the NHS needs at a price and quality all accept as being an improvement. Interestingly, the consequence of this situation is that the parallel system of private healthcare funded by the wealthier middle classes is in decline, as the private providers see higher profits and greater business opportunities in satisfying the NHS.
Of Rheumatology and Research
Where does this leave rheumatology? Primary care purchasers of rheumatology services are looking for other models of healthcare provision. Intermediate referral centers are being established where GPs with a Special Interest in rheumatology (GyPSIes) screen referrals from GP colleagues and undertake the necessary investigations (including MRIs) before either referring the patients back to primary care or selecting the few for specialist referral. Inflammatory joint disease will still be managed in hospitals, but by a possibly reduced number of fully trained specialists. Further, if independent providers can give the quality of care demanded, then the sky is the limit. Groups of rheumatologists could establish plans for the long-term multi-disciplinary management of RA, for example. Redundancy from traditional employers in NHS-run institutions looms for many colleagues.
The NHS has been a vital tool for clinical research, and access to its patients and their records have provided the backdrop for the strong legacy of academic activity in the United Kingdom. Traditionally, undertaking investigator-initiated clinical trials in the United Kingdom has been much easier than in the United States, where there is a much greater reliance on industry to fund intervention research. The U.K. government, in the strategy document “Best Research for Best Practice,” recognized the synergy between the provision of high-quality research opportunities and excellence in clinical care and is directing NHS funds toward this goal. With increasing amounts of care being undertaken outside the NHS, however, gathering whole population experience may be constrained in the future.
For my generation, a consultant job was a job for life. Today there is no guarantee for the future viability of the hospitals where we work, so we need to justify our continued employment in our specialty. The U.K. rheumatologists, with an eye to mortgage repayments and other family responsibilities, are anxious about the future and wonder why the protection from the harsh external world cannot continue.
In the waiting area of my clinic last week, I saw hordes of patients waiting an hour for their 10-minute follow-up as the agency staff employed to provide para-nursing support worked arduously, stress engraved on the faces. The “utopia” managing our own service, employing our own staff, and setting our own standards for “sale” to the NHS suddenly seemed very attractive. The NHS will continue into the foreseeable future. The question is whether the care will look more like Main Street, U.S.A., than High Street, U.K.