Doctor warns that the NHS funding gap could create a two-tier delivery system

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A retired GP and British Medical Association representative has issued a stark warning that patients could face further cuts to NHS treatment amid proposals for major changes to the delivery of services.

Paul Hobday claims the national ‘Sustainability and Transformation plans’ (STPs) announced by the Government earlier this year may lead to two-tier health provision, split between those who can afford specific medical procedures and those who cannot.

According to the Horsmonden-based former GP, who retired after three decades working in Sutton Valence, a £30billion funding gap faced by the NHS over the next five years is placing an unprecedented strain on medical services.

Mr Hobday is a local British Medical Association representative and was appointed interim leader of the National Health Action Party, which fielded 12 candidates in last year’s General Election with a campaign on healthcare standards.

He believes the Government’s transformation plan is being driven by a desire for full privatisation of NHS services and that there will be a significant reduction in the number of Accident and Emergency facilities in England.

He predicts these could be cut from 140 to between 40 and 70, as the Government looks to provide more out-of-hospital treatment.

However, Mr Hobday said he did not think services at Tunbridge Wells Hospital, Pembury would be under threat, as the hospital had been built with major private finance support.

Despite this, he remains alarmed by the state of NHS services and the fact that Maidstone and Tunbridge Wells NHS Trust has been placed in financial special measures with a forecast deficit of £23million.

Mr Hobday said: “This has made me incredibly angry, as what is happening is being done in a very subtle way without explanation.

“If services are to be reduced and privatised, then there should be honesty about that. We are going to end up with a two-tier service where if you want anything done reasonably well you will have to pay for it.”

Under the transformation plans, he claimed doctors working within the region’s newly created West Kent Clinical Commissioning Group area will be asked to provide a list of what treatments may be considered financially viable.

Mr Hobday believes there is no case for GPs to be rationing care: “Patients have to be confident their doctor has their best interests at heart, and makes decisions based on what is best clinically, not financially.

“A vital part of the doctor-patient relationship is at risk when the patient doesn’t know whether a service is denied because it isn’t necessary, or because the doctor is being forced to save money.”

The financial challenges facing NHS services in Kent has been revealed in a letter from the West Kent Clinical Commissioning Group (that is now responsible for NHS planning in the area). The Times has seen a copy of the letter.

It was addressed to GPs and read: “This year, the Clinical Commissioning Group’s (CCG) financial position is more stressed than ever before.

“The CCG office will continue trying to eliminate waste, managing contracts efficiently and holding providers to account but despite our best efforts we still have a £14million gap in our finances (2.3 per cent of our total budget).

“In order to make these additional savings and therefore to maximise the chances of making the investments described in the plan, we’d like your views on where we can find savings within the control of GPs. This is mainly in the area of prescribing and referrals.”


The Chief Executive of Maidstone and Tunbridge Wells NHS Trust is Glenn Douglas, who is also Chair of the steering group leading development of the Government’s transformation plans.

“Health and social care are coming together across the country to create ambitious local blueprints to implement the national NHS Five Year Forward View, addressing three themes: Health and wellbeing; care and quality; and finance and efficiency,” he said.

“There is broad agreement that changes are needed to how we live, how we access care, and how care is delivered. This doesn’t mean doing less for patients, or reducing the quality of care provided. It means more preventative care; finding new ways to meet people’s needs; and identifying ways to do things more efficiently.

“Our first priority is improving out-of-hospital care, which is key to the future. It is clear that too many people, especially frail older people or people with complex needs, are ending up in hospital when care at home would help many of them to retain their strength and independence for longer.

“Local people are really clear they want much more joined-up care which helps them to stay at home if possible. We need to make that work for them. We will need the community to work with us to develop local plans so we can ensure that we get this right for people now, and into the future.”

He added that some of the local services within the county had been designed to meet the needs of communities in the 1960s to 1980s, and were in need of updating for 2020 and beyond.

Mr Douglas added that along with new evidence about the best way to treat certain conditions, and revised national standards, there are funding challenges.

He conceded there were also other priority issues to tackle, including an ageing workforce that is due to retire and a lack of specialists to fill vacancies. Mr Douglas also said there was a need to provide joined-up health and social care services to deliver more effective treatment.

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