I saw an article in Pulse yesterday. The first 2 sentences sum up the situation:
The abolition of practice boundaries is to form a key battleground between the Government and the GPC during this year’s contract negotiations, as talks begin over next year’s deal for 2012/13.
Ministerial sources have told Pulse the Government is determined to press ahead with the controversial policy by next April, despite the GPC’s fierce opposition to the move.
I doubt that this issue will figure prominently in the NHS ‘reforms’ debate in the next few weeks; it will remain off the radar. But as negotiations between the GPC and Government get bogged down, we will probably see an intervention from David Cameron to this effect: ‘We are trying to offer the English public real choice here and GPs are being difficult and obstructive.’
At some point this issue will become a focus of media attention and then I hope some serious attention will be paid to it. Because when you examine this policy what you find is a total disregard for how general practice in the UK actually works. The Government’s promise of greater patient choice is really, when you look at it carefully, an illusion, a scam. New Labour’s so-called ‘Consultation’ on this issue in March 2010 was dishonest and misleading, and the Department of Health is using the results of this ‘consultation’ to justify the policy:
A DH spokesperson said: ‘The vast majority of patients told us that they want to be able to register with a GP practice of their choice in our consultation on practice boundaries. We aim to give patients far greater choice of GP practice from April 2012.’
Either the Government ministers are incredibly, grotesquely stupid, or there is a hidden agenda. I have been reflecting on this issue for over 2 years now, and I have come to the conclusion that there is a hidden agenda. Abolishing practice boundaries is really about opening up primary care to large HMO-type corporations. At present, having a practice serve a limited, defined geographical patch is quite limiting for such corporations (and there are some running GP practices already). Remove practice areas, and suddenly the possibilities open up. They can attract patients irrespective of where they live. So abolishing practice boundaries would be a form of deregulation, and the people who will gain from this will be these large corporations: ‘Liberating the NHS’: yes, opening things up, ‘liberating them’, for the large private (for profit) organisations who have been (quietly) lobbying for this for some years.
So when Government ministers say they are determined to press ahead with this policy, there is really a great deal (hiddenly) at stake. Because if primary care can be opened up to the private sector in this way, then all else will follow.
What is to be done? It is very important to be clear about the core values of British general practice and to understand how it works, and the ways in which looking after patients at a distance from the practice introduces inefficiencies, acts as a barrier to care, and is in some cases unsafe. It is important also to make clear the systemic distortions this will introduce (local patients being squeezed out by non-local people; how local integrated services will be unable to serve these non-local people).
It is important to stand quite firm against this policy and use honest plain English. This policy is a tissue of lies and distortions and omissions, a house of cards, which simply does not add up.
My intention in the next few months is to assemble further evidence to support this assertion.
In the meantime, you can read (or re-read) my email exchange with ‘Andrew Lansley’ from March-April 2010.
And keep in mind the physicist Richard Feynman’s lapidary statement:
‘For a successful technology, reality must take precedence over public relations, for nature cannot be fooled.’