The dangers of NHS reorganisation

October 14, 2004

The NHS should resist the temptation to reorganise and merge primary care trusts in the belief that it would bring benefit to patients, argue researchers in this week's BMJ.

Just over two years ago, 303 primary care trusts were created in England, each with responsibility for providing primary health care, improving health, and commissioning secondary care services for a population of around 180,000.

Hopes were high that these new organisations would be powerful agents for change in a more devolved and locally responsive NHS. But some in the NHS now believe that primary care trusts have failed to fulfil these expectations and are suggesting a further reorganisation, with mergers, to reduce their number to 100-150 across England.

So what would these mergers achieve?

There is no good evidence to show that a structural reorganisation of primary care trusts would bring benefit to patients, write Professor Kieran Walshe and colleagues. The rush to reorganise and merge also fails to recognise that many primary care trusts have already made some progress.

Reorganisations are a clumsy reform tool, and research shows that they seldom deliver the promised benefits, they add. Every reorganisation produces a transient drop in performance, and it takes a new organisation at least two to three years to become established and start to perform as well as its predecessor.

Yet the NHS is reorganised every two years or so, which probably means it sees all of the costs of each reorganisation and few of the benefits.

To propose making structural changes to primary care trusts is premature. What they need instead is the space to work on implementing current policy initiatives and seeing their effects, building relations in local healthcare communities, and securing much needed clinical engagement and improvement in service.

The Department of Health and NHS managers should resist the temptation to reach for the old panacea of reorganisation, they conclude.


Related Health Articles from Brightsurf:

The mental health impact of pandemics for front line health care staff
New research shows the impact that pandemics have on the mental health of front-line health care staff.

Modifiable health risks linked to more than $730 billion in US health care costs
Modifiable health risks, such as obesity, high blood pressure, and smoking, were linked to over $730 billion in health care spending in the US in 2016, according to a study published in The Lancet Public Health.

New measure of social determinants of health may improve cardiovascular health assessment
The authors of this study developed a single risk score derived from multiple social determinants of health that predicts county-level cardiovascular disease mortality.

BU study: High deductible health plans are widening racial health gaps
The growing Black Lives Matter movement has brought more attention to the myriad structures that reinforce racial inequities, in everything from policing to hiring to maternal mortality.

Electronic health information exchange improves public health disease reporting
Disease tracking is an important area of focus for health departments in the midst of the COVID-19 pandemic.

E-health resource improves men's health behaviours with or without fitness facilities
Men who regularly used a free web resource made significantly more health changes than men who did not, finds a new study from the University of British Columbia and Intensions Consulting.

Mental health outcomes among health care workers during COVID-19 pandemic in Italy
Symptoms of posttraumatic stress disorder, depression, anxiety and insomnia among health care workers in Italy during the COVID-19 pandemic are reported in this observational study.

Mental health of health care workers in china in hospitals with patients with COVID-19
This survey study of almost 1,300 health care workers in China at 34 hospitals equipped with fever clinics or wards for patients with COVID-19 reports on their mental health outcomes, including symptoms of depression, anxiety, insomnia and distress.

Health records pin broad set of health risks on genetic premutation
Researchers from the University of Wisconsin-Madison and Marshfield Clinic have found that there may be a much broader health risk to carriers of the FMR1 premutation, with potentially dozens of clinical conditions that can be ascribed directly to carrying it.

Attitudes about health affect how older adults engage with negative health news
To get older adults to pay attention to important health information, preface it with the good news about their health.

Read More: Health News and Health Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to