The government in the UK has tried to enforce some changes in the health care sector to reduce bureaucracy in the management staff. This is aimed at provision of quality health care services to the people. The changes have entailed the performance of a radical pro-market shake-up among personal doctors, health centers and private health institutions that are known to compete for patients. This is done to enable them to select the treatment and care in plans put forth by the government. This paper tries to explain some of the factors influencing or rather affecting reforms in the delivery of national health services.
Most health care cooperatives have considered the shift towards a ‘primary care-led NHS’ as a health strategic goal. However, it has been attested that the pace at which the change is being carried out has gone down. To ensure that the goals of most health care centers are attained, there is need to assess the progress of the reforms as well as the barricades hindering its development.
During the investigation of the nature as well as barriers to the reform, the following was some of the results that were obtained. It was ascertained that the shifts in progress from secondary to primary care was small, not strategic, gradual and not directly influenced by resource shifts. In fact, in physiotherapy, counseling, asthma, diabetes, chiropody and complementary medicine clinics, primary care-led commissioning has never been seen as the major driver of change. However, day surgery of hernia repair has been considered to have a little impact on primary care. Day care surgery has been attested to be attributed to technological advancement.
One factor that hinders the reformation of National Health Services to primary care is immobility of accessible resources. Resources have been considered the major barrier. There is a disparity in the number of resources involving primary and acute sectors with a claim of a lot of trusts. The imbalance of resources is said to distort the patterns of demand between the hospitals and primary care. “Bogdan and Taylor (1975) stated that supply creates demand; there are more vascular surgeons on call at night than GP’s.” It is also attested that the inflexibility of resources especially in the secondary sector with high amounts of fixed costs deters primary care development. In the book of Cassell and Symon (1994), they purport that expertise from secondary care is not moving out to primary care, people are protective of their own service, and they do not want to lose resources till they are sure activity will move (Cassel & Symon, 1994, p. 84).
Generally, it has been discovered that certain savings in the secondary care were being used to support various initiatives. Improved services had also been added to the previous ones instead of substituting the services offered in the secondary care.
Weak or rather lack of incentives was another barrier to a ‘primary care-led NHS’. The absence of social service support as well as other long stay facilities in the community has been attested to be a major barricade. Based on the plea from trusts, the most important incentive to move activities to primary care was capital as well as activity driven pressure. The shift to primary care should be done to reduce the number of beds, to shorten the stay of staff and to attend to a larger number of patients. Therefore, for the shift to be enforced there should be capital to finance the whole activity.
The third barrier affecting the shift to a ‘primary care-led NHS’ is the concerns in both the primary and secondary care sectors on the suitability of the shift. We will look at the attitude of secondary care towards primary care. Technicians from various cooperatives refer to the persistence of the ancient duties and attitudes of clinicians as a barrier to the shift. The health administration of various cooperatives also believes that perceived perils to the advisors power as well as to the monetary position and authority of the trust reduced the willingness of the providers to take part in the government’s policy. Some of the consultants in the UK are unwilling to give in to the government’s policy as they feel secondary care is suitable. The shift ought to be into secondary care, there are too few referrals, and patients are not being diagnosed or managed well in primary care (Hammersley & Atkinson, 1995, p. 95). Besides, a lot of doubts have been discovered to be articulated by both primary and secondary care regarding the levels of skills and adequacy of physical and human resources in primary care.
The fourth barrier to a ‘primary care-led NHS’ was the perceptions of the entire practitioners taking part in commissioning. Regarding this, we consider the cultures and attitudes of primary care. Poor facilities in the authorities are some of the restrictions on the ability to get on the shift to primary care. It was attested to, the fact that the uncertainty the government policy faced in managing certain patients in primary care preordained that the government policy was not keen either to take on an increased range of services in primary care or to use the power some of them held in the various forms of devolved commissioning, to promote such changes in the locations in which care is provided.
The last barrier to a ‘primary care-led NHS’ is lack of cooperation among the key stake holders. Based on the perceptions of most authorities and trusts in the UK, overcoming long term resource relocation issue was hindered by a lack of communication and co-operation among various health institutions. The availability of a lot of competing trusts has been attested, which barred the cooperation needed to attain the changes in the delivery of care required to fund and manage the shift. As a result, health care influence strategy was never incorporated in all sectors. There is need for organizations to cooperate transversely. There are too many professional barriers in the community — no multi-skilling and too much overlap (Hammersley and Atkinson, 1995, p. 86). There is lack of a relationship between primary and secondary care.
Heading to the finale, it is important to denote a potential barricade to the formation of a primary care-led NHS. First, individuals who were granted these authorities were either not equipped or minded to be persuaded for the shifts. It is however clear that the barriers to a primary care led NHS most probably may be some of the main factors influencing this reform. If these barriers are fixed, then the reformation of NHS to primary care will be affected.
References
Bogdan, R., & Taylor, S. J. (1975). Introduction to qualitative research methods: A phenomenological approach to the social sciences. New York. John Wiley & Sons.
Cassell, C., & Symon, G. (1994). Qualitative methods in organizational research. London: Sage Publications.
Hammersely, M., & Atkinson, P. (1995). Ethnography: Principles in practice. London: Routledge.