One GP's Protest

Dear Sir/Madam,

I am a GP. I am not a member of a political party. I work hard trying to provide a good service to our patients in Tower Hamlets.

I am grateful when policy makers come up with policies which support us in doing a good, sustainable job.

Unfortunately, in recent years this has not been the case. All too often, the politicians and DH have introduced policies and directives which make our job harder.

The Health and Social Care Bill is a prime example. It is difficult not to feel contempt for the political class and for Parliament. Politicians do not seem to understand how the various parts of the NHS work. They have misled each other to pass this Bill.

The NHS Competition regulations (SI 257) made under the Health & Social Care Act 2012 are a case in point. Assurances were made to CCGs (of which I am a member) that we would not be compelled to put out all services to competitive tendering, and now we see that these regulations contradict these assurances. This is an act of deception.

Please ensure that this is debated fully, preferably in both Houses.

Best wishes,

George

The Tredegar Practice
35 St Stephens Road
London
E3 5JD

Tim Montgomerie, blogger at Conservative Home, advises David Cameron to drop the Health and Social Care Bill: click here.

My comment to his post:

I am a GP in Tower Hamlets and therefore one of the many who have to actually deliver the health care. What I want is policies that help me deliver good quality primary care to my patients. Unfortunately, the politicians and Department of Health have for some years dreamt up policies that make my job harder, if not actually impossible. The basic problem seems to be a shocking disconnect between the aspirations (increasing patient ‘choice’, ‘modernisation’, ‘reform’) and the reality on the ground. One particular example is the issue of GP practice boundaries: all 3 parties want to abolish them. At first glance, this seems like a good idea: choice, who does not want choice. But you then need to ask: are there any unintended consequences, are there any risks, how will it work, will it work? These questions are not asked. And yet, abolishing GP practice boundaries will not actually deliver patient choice; it will make provision of good quality primary care more difficult, less efficient, and at times unsafe; it will cost more money. (Of course, there is a hidden agenda in this: it will suit some vested interests to deregulate English general practice.) For more documentation on this, see my blog at http://www.onegpprotest.org
I am perfectly happy to work with others to find ways to reform things (as opposed to sabotaging them), to make things work better. But it must be done honestly, in good faith, and the nuts and bolts of earthly reality must be taken seriously. Otherwise we will view you with contempt. As the late physicist Richard Feynman said in another context, ‘For a successful technology, reality must take precedence over public relations, for nature cannot be fooled.’

At the end of October, I watched the videos provided by GP Online of Andrew Lansley’s speech to the RCGP Conference, and his answers to questions from the audience. The speech is about 19 minutes long. A few minutes are given to the issue of choosing your GP practice, starting 11 minutes into the speech. Here is a transcription (my added emphasis):

…But I also want to talk about an aspect of choice no doubt many of you will regard as very controversial, that is choice of GP practice. The last government proposed giving people greater choice of GP practice, you’ll recall that; they initiated a public consultation and the public said they wanted choice. We also know the great majority of people will always want to choose a local GP practice.

Now I’m clear that whatever we do general practice must always remain rooted in local communities and that clinical commissioning builds on this. But there is a small proportion of patients who feel that the current system just does not meet their needs. People who may have moved away, a short distance, but want to maintain their relationship with their current practice. People who find it difficult to see a GP because they are at work whenever their local practice is open to see them. Tackling inequalities means making services more responsive to everyone’s needs.

But the last government’s proposals on choice of GP practice didn’t take account of the practicalities of achieving that choice. We will ensure that any progress is practical, and we need to think carefully about how to manage home visiting, about how patients who don’t live locally to their practice can receive urgent care, and about how information is shared. And we will make sure it is done in a way that preserves the responsibility of Clinical Commissioning Groups for the health of their local population.

Now I want to ensure that we do respond to the needs and expectations of the public, but I want to do it a way that takes careful account of what is best for patients, particularly for the most vulnerable of patients, and in ways that are, in practice, effective.

*

There are a number of important points made in this part of his speech, and we will have to work hard to hold Lansley (and the other policy makers) to these. I say this because more and more I feel that Lansley is a slippery customer and that he ‘speaks with a forked tongue’. More and more I feel this drive to abolish practice boundaries is really just a scam, and the aim is really to deregulate general practice, and introduce a very different model of general practice. In his words to the RCGP Lansley says, ‘Now I’m clear that whatever we do general practice must always remain rooted in local communities.’ Yes, I would agree with that. But then this morning, I find an Associated Press release on the just announced pilots to allow patients in Manchester, Nottingham, and parts of London (including my own, Tower Hamlets) to register with ‘practices of their choice’. In this release, Lansley is quoted as saying, “That’s why I believe patients should have the freedom to choose a GP practice that suits their lives, and not be restricted by geographical boundaries.” To my mind saying that ‘general practice must always remain rooted on local communities’ means that you will be, willy nilly, restricted by ‘geographical boundaries’: where you live is where you are. Until bodily translocation becomes possible, this will remain a constraint.

In his speech, Lansley mentioned two categories of patients whose needs needed to be met: those who move a short distance and wanted to maintain their relationship with their GP, and those whose work schedule means they cannot see their local GP. I think it is reasonable to try to find ways to meet these people’s needs. But the pilots seem to be for everyone, those wanting to register with a practice near their childrens’ school, and so on.

But perhaps the most important thing we need to hold Lansley to is this: he says the last government ‘didn’t take into account the practicalities of achieving that choice’; he is right in saying this: New Labour and the DoH did not look at the ‘practicalities’: indeed, they avoided the ‘practicalities’ almost entirely in the so-called ‘Consultation’. What Lansley does not say is that he himself was no better at thinking about the ‘practicalities’ when espousing this policy back in 2009 or 2010 (see my email exchange from March 2010).

I’m afraid that the words of ‘reassurance’ that Lansley delivered to the RCGP Conference were empty, designed to lull the audience into complacency.