Feature

NHS here, how can I help you?

Two new services will transform the NHS – and New Labour’s re-election chances – for good or ill, argues James Munro

Amid all the hype over New Labour’s ‘modernisation’ of the NHS, it is easy to miss two key developments which look set to change the public face of the health service in new and unpredictable ways – and which the government sees as embodying its ultra-modern, forward-thinking and user-friendly approach to the reform of health care.

The first is NHS Direct, the nurse-led telephone helpline announced in Labour’s 1997 white paper The New NHS, which is promised for all of England by the end of next year, with Welsh and Scottish services to follow. Currently covering 60 per cent of England, NHS Direct is intended, in the words of the white paper, to provide ‘easier and faster advice and information for people about health, illness and the NHS so that they are better able to care for themselves and their families’.

The second development is the arrival of the first 36 NHS walk-in centres, some of which – being built on existing services – are already up and running, with others due to get underway in the spring. Announced by Tony Blair last April, walk-in centres are seen by the Department of Health as a way to widen the accessibility of primary care services, offering no-appointment consultations with nurses in the evenings and weekends as well as during traditional surgery hours. While some walk-in centres will be located next to A&E departments or existing primary care centres, others will spring up in shopping centres, high streets and even airports, becoming a highly visible symbol of ‘the new NHS’.

Predictably enough, both developments have been met with professional resistance but are likely to prove very popular with the public (and hence the voters). Early research on NHS Direct found that 97 per cent of callers were satisfied or very satisfied with the service they received, and particularly valued the ability to get an immediate opinion on whether they should ‘bother the doctor’ with complaints such as fever or chest pain which were probably trivial but might just represent serious disease. Similarly, US and Canadian experience with walk-in centres suggests that UK users will find the convenient hours, accessible locations and lack of appointments of the NHS version compelling. Although some patients may prefer to be seen by a doctor rather than a nurse, the experience of NHS minor injury units, which are also nurse-led, suggests that they will be few in number.

While local GPs have been involved in both NHS Direct sites and walk-in centre proposals, the profession as a whole remains deeply critical – and threatened – by these new forms of ‘immediate access’ care, which offer alternatives to traditional primary care and seem to bypass the ‘gatekeeper’ role of GPs. Whatever the intrinsic merits of the services, the government is clearly throwing down a challenge to the ‘forces of conservatism’ it sees in general practice: evolve with the modernising NHS, or face extinction.

Yet, in a neat political twist, Labour has simultaneously outflanked the private sector. In the week following the government’s launch of walk-in centres, the company behind Medicentres – the private sector primary care centres which charge £35 for a consultation with a doctor – announced that all its outlets outside London would be closing. Although the timing may have been coincidental, the conclusion was plain enough: free NHS walk-in centres would mean no more easy pickings for commercial medicine.

NHS Direct and walk-in centres are central to Labour’s NHS modernisation because they embody powerful political messages to key constituencies: to the public, that the NHS is accessible, convenient, customer-focused; to professions, to shape up or ship out; and to the private sector (and Labour’s left-wing), that the public sector can, and will, compete with the private.

These messages will be credible only if the policies succeed in their own terms, in meeting users’ expectations and constraining ever-rising demand on ambulance services, casualty departments and GPs. But this may yet prove to be the Achilles heel of both NHS Direct and walk-in centres. There is so far no evidence – from the UK or elsewhere – that either initiative has or is likely to reduce overall demand for emergency care. Figures published by the University of Sheffield on the activity of immediate care services in first wave NHS Direct areas in the five months following their launch showed no discernible impact on demand.

Of course, it may be far too soon to expect such a new and still developing service to have much effect, and ministers have their fingers crossed that some impact on demand will appear as the service matures and becomes national. Unfortunately, the effect is as likely to be (and some commentators would say more likely to be) to increase demand as to decrease it.

Much of the public and political appeal of NHS Direct and walk-in centres comes from the emphasis on convenience, accessibility and the idea that people can use these services to ‘take the pressure off’ other parts of the NHS – long the selling points of private medicine. It would be a particular irony if the unintended consequence was to increase demand on the NHS yet further.