NHS’s prophecy is threatened as the game changes


This year is the 70th anniversary of the NHS; that embodiment of the Good Samaritan parable admirably rooted in the Christian socialism of 1940s coal miners. So, what state will our beloved institution find itself in during 2018? Here are some predictions.

Consolidation everywhere

We’ll see fewer but considerably larger GP practices and myriad federated groups, while mental health trusts will merge with acute ones and CCGs will cluster towards reinvention. All the NHS morphing will be wrapped in a deliberate fog of undefined acronyms. Legal challenges will open debate about whether we’re heading for a return to the District Health Authorities of the 1980s, or US-type managed care organisations.

NHS funding will dominate

In 2018 we’ll see a switch in emphasis from funding levels to prioritising a limited budget. We’ll see public debate of the NHS purpose – and boundaries – with IVF being a preferred battleground of NHS managers. Managed pathways will set explicit limits to patient expectations, towards a national menu of NHS services. Some waiting times will be selected to rise and all of this will intentionally foster self-pay and co-pay.

Workforce will rival funding

Brexit, student nurse bursaries, demography and years of absent planning herald a perfect storm. The Agenda for Change renegotiation will see attempts to end automatic increments and introduce performance elements to the pay scales of 70% of NHS staff. Watch for moves to introduce regional pay differentiation disguised as additional levers to recruitment.

The NHS will expand sub-cos

In my July column last year, I signalled NHS trusts which provide other localised facilities. These sub-companies are everywhere but, seriously, who in pharma is really prepared for what this means? It is a massive issue for the NHS that remains invisible to its suppliers. ‘War game’ it through, assessing the potential scenarios properly and you’ll change your current strategy, I promise.

Procurement & competitive edge

Device and service suppliers are rightly obsessed with category towers, collaborative procurement partnerships, total solutions frameworks and the other fruit of the Carter Review tree. They are busy catching up with a fragmented NHS starting to act as a co-ordinated block with shared prices, specifications and bulk buying. Now, imagine that facilitated by 50 or so collaborating groups of NHS trusts rather than 200 competing organisations.

De-prescribing & judgements

Sadly, pharma seems to have no answer to being seen as a commodity of marginal value or regarding how to gain a constituency of support for valuing medicines. We’ll soon see increasingly concerted restriction strategies and connected formularies managed by the regional medicines optimisation committees. Over the counter prescribing will be used as a screen to target so-called drugs of limited value and those targeted as high cost. The NHS may even develop its own generic supply.

After 70 years of waiting, will 2018 will be the ‘Year of NHS Monopsony’?