Health reforms risk medicalisation of social care

On Reflection, by Mark Drinkwater

Among the numerous reforms in social care and health, the prospect of GP-led commissioning consortia is giving colleagues some cause for concern. Radical proposals will see these consortia take over the health commissioning function from primary care trusts, which are to be abolished by April 2013.

This is of particular relevance in the borough I work in, where social care services – mental health, physical disabilities and older people – are commissioned jointly by the PCT and the local authority.

Although there are uncertainties about the new arrangements, I’ve been heartened by some of the murmurings from our fledgling GP consortium. Those involved seem to show great interest in addressing the wider social needs of their patients, beyond health issues.

Indeed, my own GP, frustrated by a lack of mental health provision, invested time and resources in setting up a therapeutic gardening charity. In future, GP-led commissioning will enable doctors to simply commission an existing provider to deliver such services.

But many colleagues are far from enamoured. “These are the guys who failed to order enough flu vaccines last year. How can we trust them with an £80bn budget?” one remarked, rather tartly.

Another expressed disquiet that, in palliative care, doctors are more concerned about the type of pain control medication rather than the quality of domiciliary care. Their worry was that GPs would stick to what they were familiar with – medical services – and that future commissioning priorities would reflect this.

And let’s not forget that, under the same reforms, councils will be developing health and well-being boards to oversee the local health and social care system, as well as inherit functions from PCTs.

Perhaps these fears are unfounded. But I suspect the cumulative effect of these changes is an inevitable drift towards more medicalised models of social care provision.

Mark Drinkwater is a London-based community worker

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