Department of Health reply to my email to Jeremy Hunt 2/7/15 on the #gpboundaryscam

17/07/2015

I received the following from the Department of Health on 15/7/15, in reply to my email to Jeremy Hunter earlier this month:

Our ref: DE00000945045

Dear Dr Farrelly,

Thank you for your further correspondence of 2 July to Jeremy Hunt, Jane Ellison and Alistair Burt about GP services. I have been asked to reply.

I was sorry to read that you are not satisfied with the Department’s response of 29 June to your previous email (our ref: DE00000940960). I note your continuing concerns about patients registering with GPs outside of traditional practice boundaries.

As stated in my colleague’s previous reply, NHS England will continue to review this policy to ensure that it is meets the needs of the patients who are using the service and who may wish to use it. In addition, it will address the operational issues that have arisen since the introduction of the agreement to ensure that the system remains functional for GP practices.

I note that you have not yet received a response to your correspondence to NHS England, but, as it is responsible for primary care in England, I can only suggest that you continue to raise your concerns with it.

I am sorry I cannot be more directly helpful.
Yours sincerely,

[name removed]
Ministerial Correspondence and Public Enquiries
Department of Health

————————————————————————————————————————-

Please do not reply to this email. To contact the Department of Health, please visit the ‘Contact DH’ section on the GOV.UK website.

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Of course, this is not a true reply, just another text masquerading as a reply.

Scoundrels.


The Department of Health’s response to my last email to Jeremy Hunt about #gpboundaryscam

02/07/2015

Our ref: DE00000940960

Dear Dr Farrelly,

Thank you for your further correspondence of 14 June to Jeremy Hunt, Jane Ellison and Alistair Burt about GP services. I have been asked to reply.

I appreciate your ongoing concerns. As you know, the GP contract agreement for 2014/15 allows GP practices to register new patients from outside their traditional boundary areas without a duty to provide home visits for such patients, as they previously had to.

This arrangement is designed to make the system more flexible and give patients greater freedom in choosing a suitable GP practice – for example, commuters may wish to register with a practice close to their workplace, as opposed to where they live, and people who move house may wish to continue to attend their existing practice.

The agreement was introduced in January and there are currently over 14,000 patients registered with practices away from their home since. All NHS England regional teams have arrangements in place to ensure that those patients are able to access services should they require primary medical care whilst at home.

Those arrangements vary across the country. Many regions commission the national enhanced service model, while some use the local out-of-hours services, and others commission a range of services. However, all have ensured that, should the patients registered in their area require care, they are able to provide it.

To date, NHS England has received no patient complaints or concerns about this matter through its customer contact centre or operational teams in the regions. However, it is aware of some concerns from GP practices about registration and operational issues that it has worked with them to resolve.

NHS England will continue to review this policy to ensure that it is meets the needs of the patients who are using the service and who may wish to use it. In addition, it will address the operational issues that have arisen since the introduction of the agreement to ensure that the system remains functional for GP practices.

I am sorry I cannot be more directly helpful.

Yours sincerely,

[name removed to protect the innocent]

Ministerial Correspondence and Public Enquiries
Department of Health

Please do not reply to this email

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For my next email to Jeremy Hunt and comments on this response

 


I complained to Parliamentary & Health Service Ombudsman about DoH non-replies to my concerns; they are legally not allowed to investigate

25/05/2015

In September 2013 I sent Jeremy Hunt, Secretary of State for Health, an email pointing out the problems inherent in the Coalition Government’s flagship policy to make it possible for patients to register at any practice they wished in England. I received a non-reply from the Department of Health. So I wrote again and received a similar response. So I wrote again and received a reply saying they had nothing to add to the previous emails and that unless I had something new to ask they would not reply to any further emails. For links to the emails and non-replies, click here.

So I sent a complaint to the Parliamentary & Health Service Ombudsman; in its essentials, my complaint was that Jeremy Hunt and the Department of Health had failed to address the issues I raised and respond to each of the issues raised.. I sent ample documentation to demonstrate the problem.

This is the Ombudsman’s reply:

Ombudsman Reply 1 PNG

Ombudsman Reply 2 PNG

 

 

 

 

 

 


A Question for the BBC

01/03/2015

A question for the BBC, but journalists in England as well.

On March 20, 2014 a research team at the London School of Hygiene and Tropical Medicine, headed by Professor Nicholas Mays, published their report on the Government pilot on patients registering with GP practices at a distance from where they live.

The afternoon before I was contacted by BBC London 94.9 asking if I would comment on the policy the next morning. Here is the interview:

 

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I said in the interview that as the policy was actually implemented the problems would become evident; I said that it would be ‘a mess’.

The scheme was meant to start in October 2014. At the last minute, NHS England announced that they were going to delay the implementation. Why?

A spokesperson for NHS England, said: ‘This has been an ambitious piece of work designed to increase the flexibility that patients have in choosing their GP. With such a change, we have to be completely assured that robust arrangements are in place across the country should patients who register with a GP outside their area need urgent in-hours primary medical care at or near home.

‘This has been a big undertaking and we have taken the decision that more time is needed to ensure these arrangements are fully bedded-in – a decision that has been taken in the best interests of GP practices and patients.’  (my emphasis)

The policy was implemented (very quietly) on 5 January 2015. The only media report or comment I could find was a post on the ConservativeHome blog.

I subsequently found out that ‘robust arrangements’ were not in place across the country, and the worst affected was London where there are NO ARRANGEMENTS in place. For details, see my piece in Pulse, and a subsequent Pulse article.

I wrote to Jeremy Hunt about this, copied to various media outlets, including BBC London 94.9. And yet this story has not been reported in the mainstream press. I also wrote to NHS England and NHS England London, and the CQC, the King’s Fund, the Patients Association, and the Nuffield Trust. I have not heard from Jeremy Hunt, the Department of Health, or NHS England; in fact, I have not heard from anyone.

Since September 2009 when Andy Burnham announced this policy at the King’s Fund, the press has reported only the positive sounding spin coming from the politicians, entrepreneurs, and the Department of Health, and have been universally silent about the numerous problems inherent with this policy. It is as though there is a news blackout…

Why?


It is now crystal clear: the Choose your GP Pilot ‘independent evaluation’ in no way evaluates the actual policy

12/04/2014

Yesterday the practice manager of a large Tower Hamlets practice (and CCG Board member) and I went to meet with Professor Nicholas Mays and two other authors of the Evaluation of the choice of GP practice, 2012-13 at the London School of Hygiene and Tropical Medicine.

We outlined the reasons why abandoning practice boundaries in Tower Hamlets would not be in the interests of our aim to provide good quality primary care services to our local communities. Quite to the contrary, why it would be harmful and destabilising.

We had an interesting conversation about the pilot, about the various competing aims, about unintended consequences, about politicians, and about pilots.

I believe their report is well written and contains a number of important points, and they have done a serious piece of work. But they were clear that their evaluation only evaluates the pilot, and not the policy. The pilot had small number of patients and in no way ‘tested’ the policy; in fact, the sorts of risks I have highlighted in my Submission to the Health Select Committee are not revealed by the pilot, they are hidden. (I expressed these concerns in an article for Pulse in December 2012.)

It is as though you invited smokers over the age of 70 to meet you at the top of a tall hill, and you asked them if they liked smoking and if it had impacted negatively on their health. It is likely that they would say that they enjoyed smoking, and it caused them no problems (hence their age and ability to get up the hill). You might conclude that smoking was a harmless pleasure.

 


On recognising and naming MOOspeak from @Dhgovuk & @DeptHealthPress

19/01/2014

The Department of Health is a large organisation, with different departments performing different tasks. No doubt, there are some departments carrying out noble and important work, and many of the civil servants working at the DH are, I am sure, dedicated to trying to make a positive difference to the provision of healthcare in the UK (or is it just England now?).

But there are some departments, the ones handling the more politicised policies, that are having to plan, promote, and implement policies that are not actually positive ones, and where there are significant unintended consequences. During the debate surrounding the Health and Social Care Bill many criticisms and misgivings were articulated. The Department of Health was then having to defend these policies and the methodology by which they were being planned, and this was most evident in the statements issued to journalists in response to the critiques.

‘A spokesman for the Department of Health said, ………’; ‘a spokeswoman for the Department of Health resplied…..’. These statements were understandably designed to minimise the damage done by the critique of the moment, but it meant that they were often fatuous and disingenuous. And what was frustrating from the point of view of those of us who work within the health economy was the, for the most part, the journalists just accepted these statements at face value, even if they contained falsehoods.

An example of this was when, in February 2012, 154 senior paediatricians (including 19 professors) wrote a letter to the Lancet to voice their concerns about the damage that would be done by the Bill. This naturally received attention in the press.

The Department of Health’s response, as quoted in this article:

A spokeswoman for the Department of Health said: “We have listened and substantially strengthened the Bill following the listening exercise. It’s not true to say that the Health and Social Care Bill will fragment children’s healthcare. In fact, the Bill will help address the very concerns about fragmentation that the experts raise. It will help the NHS and other public services work together better for children, young people and their families. These 150 individuals represent just over 1% of the total members of the Royal College of Paediatricians and Children’s Health and cannot be taken as an accurate representation of the College, who we continue to work with.”

The template for these responses is seems to be something like this:

a) make a positive-sounding statement (‘we have listened and substantially strengthened the Bill’); b) refute the criticism (without responding to the substance of the criticism); c) make some positive-sounding noises about the policy (the Bill ‘will help the NHS and other public services…’; and, sometimes, d) undermine the credibility of those voicing the concerns (as in this case).

What struck me about this example at the time (and why I kept the links) was that some anonymous spokeswoman at the Department of Health (who almost certainly had no experience working in paediatrics or medicine and was in all likelihood a PR person) was implicitly afforded equal status in this debate. So we had some paediatricians saying one thing, countered by the (unsubstantiated) assertions of a ‘spokeswoman’ without any qualitifications. Paediatricians 1, Department of Health 1.

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What we need is a basic analysis of these communications from the Department of Health, a deconstruction. And where the DH statements are dishonest, disingenuous, misleading, and just meaningless spin, they should be named and ‘outed’ in an efficient way.

For the moment, I am going to use the term ‘MOOspeak’, but I would be happy for any suggestions for a better term. Remember, it needs to be short so able to be used on Twitter.

I would suggest that if a journalist feels the the statement they receive qualifies as MOOspeak, that they write something like:

A spokeswoman from the the Department of Health, issued this MOOspeak statement: ‘Blah blah, etc…’

Or: A MOOspokesman for the Department of Health said, ‘Blah blah….’

Or: In a statement from the Department of Health, which sounded awfully like MOOspeak, …..

I think they would issue fewer MOOspeak statements and we would have a more honest discussion.

And then, perhaps, we could move on to politicians and their ‘speak’….


I smell a rat. Is Monitor working in the interests of patients or free market healthcare?

27/10/2013

I recently set up a Google news alert for articles on GP practice boundaries.

It threw this article up this morning.

“Monitor senior policy adviser Paul Dinkin, the man heading its primary care consultation, said his initial conclusion was that Monitor would play a major part in primary care.”

“Mr Dinkin said his review was looking at barriers to entry into general practice, such as practice boundaries and registered lists.”

“He said the BMA and the RCGP were wrong to say general practice needed more funding. ‘Our suspicion is not more money for the current model, but to rethink who does what.'”

And my suspicion is that Mr Dinkin does not know a great deal about the ecology of general practice, and that he has little interest in finding out.

Checking on the Monitor website, I found a Call for evidence on general practice services sector in England.  Issued on 1 July 2013, deadline for responses 1 August 2013. So I won’t be offering my views.

Who is Paul Dinkin and what is his background? I could find precious little online. Even on Monitor’s website there is no information.

Can we have some transparency, please?


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