Healthcare is not a business

Healthcare is not a business!

Today I was reading a report talking about healthcare as an ‘industry’, a business. This language is unhelpful, but does demonstrate how wrong we have got things. A business works to satisfy customer needs profitably. It is built on three line accounts – revenue, expenditure and profit. We would drive up demand to build revenue, control expenditure to increase profit. We might diversify and introduce new services to ensure that we can continually grow the range of customers, the services/products that we offer to continue to build revenue. When times get tough we review expenditure and look to new ways of growing revenue to ensure a constant or growing profit.

The NHS and Social Care is different. There is no profit and we just have to match revenue – whatever the government gives us – to expenditure. It is stupid to drive demand when revenue does not match it. We end up with overworked and demoralised staff, a restriction to new technologies and growing risk because we can’t guarantee quality. For the Department of Health to talk about 500,000 more A&E attendances and millions more GP appointments in extended hours is just a measure of failure and an extra 2.1% in staff as a measure of success is frankly ridiculous.

Demand will be the death of the NHS and we need to do more. So let’s start an open discussion.

Managing demand.

While demand increases we need to look at less expensive ways of delivering care. We all know that A&E is more expensive than OOH, which in more expensive than General Practice, which is more expensive than Community Pharmacy. Urgent and emergency care collaborative should include all providers of first care and the investment and effort should be in the least expensive provider. This should purvey thinking and investment strategies. Initiatives such as ‘PharmacyFirst’ should be supported. I note that the Secretary of State feels that NHS England has made good progress in supporting community pharmacy reform – but I would generally disagree. It is about time HEE was supported in offering training opportunities to community pharmacists outside of commissioned services. You are simply wrong to expect them to take up the slack without supporting their development. The core contract cuts may have encouraged community pharmacy to adopt a new business model (now they are real businesses), but the reduction in commissioned services is not helping. Perhaps 10% of NHS111 referrals to General Practice could have gone to community pharmacy. 1.2million GP appointments could be saved this winter through the Strep A sore throat test and treat service and simply creating a direction of travel might save more appointments.

When you see stresses in the system you need to work out how to relieve them, get other services involved, find other ways rather than simply funding more of the same.

This is where ‘business’ is important. Community Pharmacy is a business – if you cut its revenue then expect a reduction in services to compensate. It is just not the way to do it.

Reducing demand

We really have to start considering ways of creating health as a mechanism to reduce demand. This is not about engaging lower cost healthcare providers, but not having to engage a provider at all. It is about creating the situation where people can be in Control of their health, Connect with others and have Confidence. I am seriously worried about the paternalism in the NHS that always wants to define what is right for me. The way that we run the NHS simply traps people in the system and we need to set them free to create their own health, take control and make their own informed decisions. The Government should support situations which increase our ability to be in control. I am sure that people know the better decisions and would take them if it was easier to achieve.

One day the NHS will support the view that it is my health and my condition; give me access to the monitoring and testing without visiting my GP. GPs are not responsible for my condition – I am – and I should be able to ask GPs to advise me on the best ways for me to control my condition.

Health creation is the only way forward to reduce demand. Now we have thousands of healthy living pharmacies – how can we develop them to adopt health creating practice and be in a better position to help communities create health?

So in conclusion – healthcare is not a business, but community pharmacy is – just think about it.


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