Dr Luke Evans

The Health Secretary and his team have perfected the sales pitch for NHS reform. The problem is that the detail never seems to arrive. We have seen a 10-year health plan with no delivery chapter, and a plan for the abolition of NHS England with no price tag; the Health Secretary has announced 10 new “straight to test” referral pathways, but could not name a single one; and now we are seeing a new GP contract with more questions than answers. Calling something modernisation does not make it reform. If the rules and the delivery are unclear, it is simply confusion with branding. “Advice and guidance”, for example, appears in practice to create a single point of access for referrals. GPs will no longer be able to refer patients directly to a consultant, even when they believe that it is clinically appropriate. Will the Government publish the clinical evidence supporting that approach? Who will carry the legal responsibility if, in a GP’s professional judgment, a patient needs to see a consultant but must first go through “advice and guidance”? If advice and guidance becomes mandatory as an extra layer before referral, are the Government not, in essence, managing the waiting list by keeping patients in primary care rather than treating them in secondary care? Waiting lists will look shorter on paper, but patients are simply waiting elsewhere in the system. Can the Minister clarify exactly where those patients will appear in the official waiting list figures? The contract also requires patients whose cases are deemed “clinically urgent” to be dealt with on the same day, but it does not define “urgent” or explain what “dealt with” means, and that really matters. Let me therefore ask the Minister three clear questions. First, when will the Government publish the clinical definition of “urgent”—a patient’s sick note is urgent for the patient, but not clinically urgent—and what counts as a patient’s being “dealt with” on the same day? Secondly, the Minister has talked about access, but how can practices guarantee same-day responses when demand is uncapped and definitions are not published? Finally, with advice and guidance being required as a mandate beforehand, how will we ensure that patients are protected, and where will they appear on the waiting lists?