My latest email to Jeremy Hunt on #gpboundaryscam

14/06/2015

Dear Jeremy Hunt,

I am a GP in Tower Hamlets. I have emailed you on a number of occasions regarding the Government’s policy on allowing patients to register with a GP at a distance from their home. My last email pointed out that there are actual serious flaws in the way you have implemented this policy which went live on 5/1/15.

I have received a reply from the Department of Health, which was typical in that it does not address the fundamental issue of safety and avoided mentioning the rather large elephant in the room: that the policy simply does not work, and that for people who are actually too ill to get to their registered GPs it is unsafe. This is something the Health Select Committee should look into.

Incidentally, I complained to the Parliamentary and Health Service Ombudsman about the Department of Health’s wholly inadequate replies to my emails. They replied, politely, saying they are not able to deal with my complaint because, by law, they are prevented from investigating complaints about policy decisions taken by government departments.

In addition, I have an email exchange going with the NHS Choices website who are, understandably, reluctant to publish my comment on their webpage dealing with this policy.

So we have an interesting situation: successive governments have promoted this policy since 2009, apparently unaware of the foolishness of their claims and promises. My GP colleagues and I, as frontline workers who have to deal on a daily basis with the practicalities of delivering general practice services, have tried to warn you but you do not listen. And when you actually implement a policy which is operationally unsafe, I cannot find a way to make a complaint. I have of course emailed NHS England (two separate threads, click here & here) but I have had no reply.

Normally, under these circumstances, one might expect the media to pick up this story: ‘Government pushes through flawed policy by misleading the public’ etc etc. But the mainstream media seem to have singular approach to this issue: they will publish the Department of Health’s fanciful promises, but when it comes to the multiple flaws in the policy they are silent. They behave as though they have been paid off. Or perhaps it is the Emperor’s New Clothes dynamic. Strange.

I will close with a question which I am sure you and the Department of Health will not answer: if a citizen, a frontline worker, discovers a significant flaw or flaws, in a Government policy and the Government and the relevant civil service department (and the Health Select Committee?), pretend it is not happening; and if a complaint cannot legally be investigated; and if the media will not ask some awkward questions–what then is the citizen, the person on the ground, to do next?

Best wishes,

George

The Tredegar Practice
35 St Stephens Road
London
E3 5JD

“For a successful technology, reality must take precedence over public relations, for nature cannot be fooled.”  Richard Feynman, Physicist


My email to Jeremy Hunt on a significant risk with the GP Choice scheme

15/02/2015

Dear Jeremy Hunt,

I am a GP in Tower Hamlets. I sent you three successive emails (7/9/13; 13/10/13; 11/1/14) warning of the risks of your government’s flagship policy to abolish GP practice boundaries. I received 3 non-replies from the Department of Health (see links below).

I am now writing to bring to your attention not potential future risks but a significant current actual risk. As you may know, the policy was rolled out (very quietly) on 5 January 2015. The intended start was for October 2014 but this was postponed until 5/1/15 because, in the words of a spokeperson for NHS England in September 2014.

‘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.’

I have discovered that there are no ‘robust arrangements’ in place in London; in fact there are no arrangements. I have sampled three separate NHS 111 London sites and none of them were aware of the policy having been implemented, and none of them had a list of local GPs who had signed up for the out of area Enhanced Service. I was told that a patient not registered with a local GP would, if they needed to see a doctor in hours, be advised to go to an urgent care centre or to A+E. If the patient was too ill and needed a visit, one of the supervisors told me, they would have to use SOS Doctor Direct and then bill the patient’s GP surgery for the cost.

This is an unsafe situation. Why has this been allowed to happen? I have emailed NHS England about this but have not had a reply.

*

Incidentally, in 2 of my emails to you I asked a number of quite specific questions about the alleged benefit of parents registering near their child’s school; the Department of Health did not answer these questions. I have now created a video illustrating how this proposal, which might sound attractive on the surface, simply does not work and would actually create problems for a family. That you, the Department of Health, and NHS England should be encouraging people to sign up to something fundamentally flawed is truly surreal.

I do not expect you to do anything about this; I expect, at best, a ‘non-reply’ from the Department of Health. But I am writing so that it is at least on the record.

Yours sincerely,

George Farrelly

The Tredegar Practice
35 St Stephens Road
London
E3 5JD

@onegpprotest
#gpboundaryscam

 

Links:

1 My emails to Jeremy Hunt and Department of Health non-replies

2 NHS Choices webpage on Choose Your GP

3 My video on the consequences of registering with a GP near your child’s school

 

 


If abolishing GP boundaries is such a good idea, why won’t the Department of Health answer some basic questions?

25/01/2014

I have written on three occasions to the Secretary of State for Health, Jeremy Hunt, copied to the Health Select Committee members (and miscellaneous media outlets) about some very basic problems with the Coalition Government’s flagship policy to abolish GP practice boundaries.

On each occasion, I have had replies from the Department of Health. None of these replies have remotely addressed the warnings I have raised.

It is as though an able seaman were to send an iceberg alert to the officers, and receive in reply the rota for cleaning the toilets on Deck C. Not once, but three times…

In the third reply, the Department of Health official writes:

“I note that you have contacted the Department of Health previously on a number of occasions about this issue.  The information given to you by my colleagues is the most up-to-date and accurate available, and there is nothing further I can add to this.  The Government’s position remains as set out in previous letters.I am sorry if this is not the reply that you were hoping for, but as there is nothing further that the Department can add, we must now consider this matter to be closed. ”

*

First email to Jeremy Hunt

Department of Health response

Second email to Jeremy Hunt

Department of Health Response

Third email to Jeremy Hunt

Department of Health Response

*

NHS England have done no better; see their reply, and my second attempt to get them to answer my questions.


My warning to Jeremy Hunt on the dangers of abolishing GP practice boundaries, 3rd attempt

11/01/2014

Dear Jeremy Hunt,

I sent you emails on 8/9/13 and 13/10/13 warning you about the problems associated with a Coalition Government proposed policy. Consider these ‘complaints’, ‘whistleblowing’. The replies I have received do not in any way address the concerns I raise. You have said that hospitals need to address complaints transparently and be responsive to members of the public, that problems should not be hidden. You have said that staff who neglect patients’ safety should be liable to criminal prosecution.

So far you have evaded the issues I have raised in my previous emails. I am saying that this policy is unworkable, that in some cases it is unsafe; overall, it will impact negatively on the functioning of general practice. If harm comes to patients because of this policy and you and others have wilfully neglected a proper risk assessment, will you be accountable?

I require the following by way of response:

A. I challenge you and your officials at the Department of Health to respond, point by point, to my submission to the Health Select Committee.

B. In the Department of Health’s media launch of the so-called ‘pilot’ in December 2011, we read: “The pilot, which will begin in April 2012 and last for one year, will also come as a relief to people who are moving home and wish to remain with their preferred practice, and families who would like a practice near to their children’s school.”

This detail of families registering at a practice near their children’s school is repeated in the evaluation Proposal submitted by Professor Mays in May 2012.

So you think this is a good idea? I challenge you and your associates at the Department of Health to answer the following questions about this particular idea:

1. What benefit accrues to a family if they register with a practice near their children’s school? Why would they want to do it?

2. How would this work practically? (Details please, full details of the mechanics of this).

3. Are there any risks or problems with this proposal?

Perhaps journalists can have a go answering these questions; and Andy Burnham; and Stephen Dorrell and his colleagues on the Health Select Committee.

Come on, have a go. Let’s see if the emperor is wearing any clothes.

Yours sincerely,

George Farrelly, GP

The Tredegar Practice
35 St Stephens Road
London
E3  5JD

Resident in London N7


My second email to Jeremy Hunt on the fraudulent GP practice boundary policy

13/10/2013

Dear Jeremy Hunt,

I sent you an email on 8/9/13 raising concerns about a Government policy. I received a ‘reply’ from a Department of Health official (for my original email and the reply, see below). A first year GCSE student would have no trouble seeing that this is no reply at all: it is a bland, seemingly innocuous, description of the ‘pilot’ into general practice without boundaries. It does not address my concerns at all (1).

I ended my first email with a quote from my submission of May 2013 to the Health Select Committee:

I am making what is a serious and unsettling charge. The people involved in promoting this policy (ministers from both Labour and Conservative parties, and policy makers at the Department of Health) are trying to implement a policy which by its very design will cause primary care services to malfunction and cause real harm. These people have not done an honest risk assessment. They have promoted the policy in a very biased and misleading way. The result is that they have misled Parliament, journalists, and the citizens of England. If this policy were a financial product, it would be deemed mis-selling. In some senses, it is fraudulent (2).

The DH reply only reinforces my hypothesis that this policy is a scam, a deception, a confidence trick.

*

I have been following the development of this policy for over 3 years now. I have not been able to find an example, a metaphor, which would help people to understand the sheer stupidity of this policy. And then last week I came across a news item that I think is of help. Briefly, it is this: a British entrepreneur was convicted in April 2013 for fraud; his fraud was selling bogus bomb detectors to the Iraqi government. He made a lot of money; the bomb detectors did not work; innocent people were blown up; these bogus devices are apparently still being used in Iraq to ‘protect’ the citizens.(3)

I believe this story, this parable, offers a structure that helps make sense of the policy which you, as Secretary of State for Health, have inherited. There is a product, a technology, which is said to perform a function (detect bombs, avoid disasters); the technology is marketed (presumably there was promotional material; presumably it came in a box with reassuring messages on the box); the buyer is persuaded to pay for the technology; the technology is put to use; the technology does not work.

(This sad, shocking story raises a number of questions which I will not address here; but one question is this: why did they not test the device? Presumably the entrepreneur and his firm told the buyers that it had been tested, perhaps they said the device was already being used in other war zones).

Now let us come back to the policy of abolishing GP practice boundaries. British general practice is a complex technology which by its very nature is local, geographically based. Our experience has been that when people move away from the practice area it is no longer possible to look after them properly, especially if they are unwell. So when I heard politicians saying that boundaries were old fashioned and limited choice I was bewildered. I heard Andy Burnham say that this policy would transform the NHS from ‘good; to ‘great’, that poorer patients would be able to take advantage of services that were offered to richer patients; I heard them say that this policy would promote competition and that this would drive up quality. Most of what I heard was very foolish, it did not make any sense, it was nonsensical, it would simply not work, it would not deliver what they were promising, it would actually undermine our work.

Now just in case you think I am some sort of eccentric, some nutty GP who has an absurd bee in his bonnet, ask yourself this: why did the former GPC Chairman Laurence Buckman describe this policy as ‘bonkers’? And why did the annual LMC conference in 2011 vote unanimously (something unheard of) a motion urging the GPC to resist this policy ‘staunchly’?

So, Mr Hunt, what I am saying is this: the technology your Government are proposing simply does not work. Your predecessors, the various promoters of this policy (politicians, the Department of Health, aided by compliant journalists and think tanks) have presented the public with an attractive box, with catchy packaging, which promises a great technology. But the device in the box is bogus, it does not actually work. Just like the bogus bomb detector. They have done no honest testing of the technology in the box. You pretend to test it, as with the sham pilot and the questionable ‘evaluation’ (4).

You see, Mr Hunt, I understand the technology. This is my area of expertise. And I am saying that the technology that your Government is promoting is very faulty and it will not deliver what you are promising. Either you are all remarkably stupid or you are perpetrating a fraud.

The entrepreneur who committed the bogus bomb detector fraud has been arrested, charged, convicted, and sent to prison for his fraud (but not, apparently, for the harm he has caused to a large number of people).

If I am correct in my hypothesis that the Department of Health and ministers are engaged in a deception, a fraud, then should they be charged? And if not, why not?

So what do I propose? I propose that the Health Select Committee open the box and scrutinise the contents carefully, honestly, dispassionately. But are they capable of doing this? I am sceptical. When the Chairman of the Health Select Committee, Stephen Dorrell, was phoned by a Pulse journalist following my submission in May, he said he was broadly in favour of the policy: ‘Where there is choice different people will have different ways of solving the problem and provided that they are all consistent with the commitment to universal delivery of high quality care then I think that the [option] which allows people to consider different ways of solving shared problems is in the interests of all patients.’ (5) This is typical of the rhetoric that is used when discussing this issue; the word ‘choice’ is inevitably used, ‘high quality’, ‘interests of all patients’. But it means nothing. It is all packaging, spin. It does not address the technical problems at all. Mr Dorrell needs to open the box and look at the technology inside the box, not to approvingly describe the packaging.

There is of course another very important question here that I feel, as a professional and as a citizen, needs to be addressed. What is wrong with the system that we have come to this? How is it that policy has been allowed to develop in this way? This is not just a ‘blunder’.

So perhaps it would be better for an independent body to look at what is in the box.

I would also propose that journalists wake up. Look inside the box, ask if it really performs the functions that the promotional material claims (but, for heavens sake, do not use the DH as your source of information). Ask questions; educate yourselves, try to understand the ecology of UK general practice. If any of you are interested, I would be happy to take you through the issues in plain English. Who knows, there might be an Orwell Prize at the end of it all.

Mr Hunt, you have a real problem here. If you implement this technology the problems will become apparent, the design faults will be exposed. You will no longer be able to fall back on the attractive box and the glossy promotional material. You will not be able to say you were not warned.

In the end, Mr Hunt, you cannot get away from this reality, eloquently stated by Richard Feynman: ‘For a successful technology, reality must take precedence over public relations, for nature cannot be fooled.’

Yours sincerely,

George Farrelly

The Tredegar Practice
35 St Stephens Road
London E3 5JD

Notes:

1. The reply from the DH: for reply & my comment; for my first email to Jeremy Hunt
2. For my Submission to the Health Select Committee
3. Bogus bomb detector fraud
4. Questionable ‘evaluation’ of pilot
5. Pulse article ‘MPs to investigate GP practice boundaries’; I do not think they have actually investigated this issue. Nobody has called me, I have not seen it mentioned in the announcements from the Health Select Committee.