My email to ‘Choose Your GP’ pilot enthusiast


The Department of Health’s press release for the Choose Your GP Pilot, contained this endorsement by a GP:

A Westminster GP Ruth O’Hare said:

“This initiative will mean that commuters working in the heart of London will in future have far greater flexibility around their choice of GP, enabling some to choose to see a GP closer to where they work.

“I welcome this exciting initiative which the Department of Health is resourcing as it offers patients greater access to NHS care at a time and place that is convenient to them.”


I emailed this GP as follows:

From: Farrelly George (TOWER HAMLETS PCT)
Sent: 23 April 2012 07:38
Subject: Yours views on ‘Choice of GP Practice’ pilot

Dear Ruth O’Hare,

I am a GP in Tower Hamlets. I will confess that I am sceptic with respect to this pilot, but I read in the DoH press release that you are an enthusiast. Seeing as how you are in essence giving a public endorsement for this policy, can I just ask for some very brief clarification (just ‘back-of-an-envelope’ thoughts)?

1. ‘I welcome this exciting initiative…’: please name 3 things that you find exciting about the policy.

2. Do you think there are any risks with the policy? If so, would you name three?

3. With respect to the broader policy of abolishing GP practice boundaries altogether, are you in favour of this proposal as well?

Many thanks.

Best wishes,


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

Sent: 01 May 2012 09:37
To: Farrelly George (TOWER HAMLETS PCT)
Subject: RE: Yours views on ‘Choice of GP Practice’ pilot

Dear George,

I have discussed your email with local colleagues.

The response seems to be that this is a local issue and needs to be decided at CCG level and amongst local practices.

Best wishes


From: Farrelly George (TOWER HAMLETS PCT)
Sent: 25 May 2012 12:34
Subject: RE: Yours views on ‘Choice of GP Practice’ pilot

Dear Ruth,

I would have replied earlier but have been away.

Your endorsement on the DoH website, quoted in the press, did not say ‘This might work for some areas, but needs to be discussed at a local level’, but gave the impression that you thought this was a commendable policy.

I would ask again: are you able to give answers to the 3 questions I raised in my original email? Why do you, and indeed your local colleagues, think this is a good thing for general practice inWestminster?

You see, I believe this policy to be very flawed, very misguided. I have been unable to find anyone able to give a coherent and credible argument in its favour (Department of Health; Kings Fund; politicians; GP proponents). The magic word ‘choice’ is used, but nobody looks realistically at what this means in practical terms; proponents point to the government ‘consultation’ of 2010, allegedly showing that the public support having ‘choice’, but the consultation itself was in many ways a deception, painting a one-sided picture of what this ‘choice’ would involve, and omitting mention of any risks.

You are a GP in a position of authority; you have lent your good name to promoting this policy. Why?

Best wishes,


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

East London LMCs advise boycotting ‘Choose Your GP’ pilot


Pulse has published an article on this, together with the letter.

My comment to the Pulse article:

Congratulations to the East London LMCs for taking this necessary step. Not only will the commuters using local GP practices be using local resources in terms of secondary care, community services, and prescribing costs, but do local practices really have the capacity to look after these additional patients without distracting them from their local registered populations?

PCT clusters throughout England are having to put in place contingency plans to look after patients who register at one of these pilot sites, but who then fall ill at home and need a GP. What is the cost of all of this? Where is this money coming from?

At all sorts of levels this is a crackpot policy. Either Lansley and the secret agents at the Department of Health are remarkably stupid, or, more likely, this policy is actually a smokescreen to de-regulate English general practice. Removing practice boundaries will open up general practice to an entirely different model which will be ‘liberating’ for organisations like Virgin Care, but will undermine British general practice.

They call this a pilot and they say that it will be ‘independently’ evaluated. I predict that as with other piloted policies, that plans to implement the nationwide roll-out will be made before the (sanitised?) evaluation is made public.

I believe it is possible to stop this policy, but this will require persistent clear-headed resistance to the impracticalities & inefficiencies that will inevitably be proposed. A light needs to be shone on this policy: why did none of the 3 political parties carry out a proper risk assessment of this policy? Why did the Department of Health avoid almost any mention of these risks in the so-call ‘Consultation’ two years ago?

It is really just a confidence trick, and the choice it promises is an illusion. The GP you’ve heard such good things about is actually working at full capacity already. The well-functioning practice you may have heard about works well with this population size, within this geographical area. Increase the list size, change the geography, and the system changes.

For more on this, see my blog

My initial comment on Government pilots on boundary-free general practice: is it a fraud?


The Government and Department of Health recently announced pilots for commuters to be able to able to register with GP practices near their place of work. Tower Hamlets, City and Hackney, and Westminster are amongst the pilot sites.

There was an article in Pulse this past week which quoted some of the misgivings of affected LMCs (Local Medical Committees).

I posted the following comment to the Pulse article (as well as the similar story in GP Online):

I have been thinking about this issue for some time now. I know that a minority of GPs are ‘excited’ by it, but I am not clear why. I practice in Tower Hamlets; when people move away, it becomes in many ways unworkable to continue to look after them as patients. This has been our experience. Yes, there are some groups of patients who need a workable solution: use a sensible methodology to find that solution, but be clear-headed and honest about the risks and problems.

I fear that this whole ‘Choice’ issue is just a Trojan horse. The Choice offered is an illusion, and hidden within this horse are all sorts of problems, unintended consequences, anomalies. I hope in the coming months this issue will be aired, the deceptions made clear. It is essentially a fraud. The ultimate aim (covert) is the de-regulation of English general practice. De-regulation in the sense that financial services were (under concerted pressure from lobbyists) de-regulated, leading to financial gains for some, but (undeclared) risks and subsequent losses for many clients. General practice without boundaries is, I think, the Holy Grail for some. But it won’t give us good quality, community based, integrated, family medicine. Indeed, it will undermine it.


This story will develop in the coming months, as the practicalities begin to bite.