NHS shake-up
Xavier Nalletamby is optimistic about the bigger role for family doctors in the latest reforms but there are challenges too. Frank le Duc reports
Xavier Nalletamby is at the forefront of the government’s health reforms in Brighton and Hove. He is the family doctor who will head the new organisation in charge of health spending in the area. It’s called the Brighton and Hove Shadow Clinical Commissioning Group (CCG). In a year’s time it will drop the word Shadow from its title when the local primary care trust (PCT) is abolished and the CCG has to walk unaided.
Dr Nalletamby, 53, is the senior partner at St Peter’s Medical Centre in Oxford Street, Brighton, between London Road and The Level. He came to Brighton in 1983 to work at the old Royal Alexandra Children’s Hospital in Dyke Road. And even today he mostly sees children.
Many in the medical profession have spoken out about the latest health reforms. Dr Nalletamby seems less interested in the structure and shape of the system and more concerned to ensure that it works.
He said: “Almost all GPs just want to be GPs and see patients but all of us recognise that there are areas where things could be done so much better. This is an opportunity for all those who feel strongly enough to get involved. This wouldn’t be my first choice of career (chairman of the CCG) and I’m eager to get back to my full-time practice but only once this has been achieved.”
As local GPs become responsible for spending decisions, he is conscious of potential problems. Some patients fear that decisions will be made for financial rather than clinical reasons.
Dr Nalletamby said: “People do worry about it. The trust between doctor and patient is based on a doctor’s expertise and that money doesn’t enter into it. And that mustn’t change. In the scheme of things somebody has got to make sure that the money works. We’ve all got to agree what’s best practice and stick to it. But there are a lot of variations.”
Part of the rationale for the shake-up of the NHS is to contain spending. The CCG will have a smaller budget than the old PCT. But Dr Nalletamby said that health spending worked out at about £2,000 a head – or half a billion pounds in Brighton and Hove.
He said: “The money available to us isn’t going to go up for the foreseeable future so we have to make sure that what we do spend we spend for the maximum benefit. That does sharpen the mind. We’ve got to get rid of duplication.”
He compared the CCG with the engine in a car. He said that we tend not to look under the bonnet unless something goes wrong. The same ought to be true of the CCG which funds and designs services but doesn’t provide them – that’s the job of doctors, nurses and hospitals.
Even so, he hopes that patients and the public will notice the difference: “I hope we’re going to see new services which are designed with more clinical input and more public input.” He has a patients group at his own practice and is pleased by their enthusiasm and, in some circumstances, expertise.
He added: “What I really want to achieve is a system – a real connection between all parts of the NHS in Brighton and Hove – so that if a patient turns up anywhere in the NHS he or she can get help and be treated. We need much better relationships between the hospitals and GPs and a faster transfer of information.
“Clinicians are going to be round the table. They weren’t before. They were in front of their patients. However, they have a unique understanding of how things work which managers don’t have. They’re going to have to sit down and identify the problems and solutions and get management to implement them. It is a dilemma. I really want to be in front of my patients. I’m torn because I know that I can help improve things in a way that nobody else can who hasn’t got my experience. My compromise is that I’ll give it a few years and then go back to my patients.”
