My question to Lib/Dem MPs on GP practice boundaries


Dear Liberal Democrat MPs,

As you will be aware, one of the policies in the Health Bill is the proposal to abolish GP practice boundaries. You may be less aware that most GPs think this is a very bad idea, and that the GPC will be resisting this ‘staunchly’ in their negotiations with the Government and Department of Health. It is said this this is to be a ‘battleground’ in the coming months.

I am a GP in Tower Hamlets. I have written to you as a group before.

I am writing now to put to you the same question I put to Andrew Lansley in March 2010: do you have a position paper, feasibility study, or related documentation which gives evidence that you have considered not only the benefits but also the risks of this idea [abolishing GP boundaries], and that you understand the nature of general practice (and here I mean quality general practice)?

I don’t know who within the Lib/Dem party is best able to answer this question so I am writing to you all.

Best wishes,


The Tredegar Practice 35  St Stephens Road London E3 5JD!/onegpprotest

Plot Against the NHS? Read this:

Calling on doctors to sign letter to The Times; deadline Monday morning 5 Sept


A Tweet this morning mentioned a letter to the Times for doctors to sign; I tracked it down, and reproduce it below. If you sign up, make sure you give your title, name, place of work and phone number (this is to ensure people are for real).


Would anyone be willing to sign the following letter to the Times?

Please feel free to forward to medical colleagues, including people outside Liverpool, or to circulate by any other means you can think of.

Unfortunately the timescale is again very pressing – I will need to submit the letter on Monday morning for publication on Tuesday (when the bill returns to the commons). Please ask people to reply to me at <>, and to include their job title and location.

Thanks, jon

Dear Sir,

On 20 July, the national Council of the British Medical Association (BMA) agreed to start a public campaign calling for the complete withdrawal of the Health and Social Care Bill. This was in recognition of the medical profession’s overwhelming rejection of the Bill, and a failure of the government to address adequately concerns about the further privatisation of the National Health Service. It was also agreed that the government is misleading the public by repeatedly stating that there will be no privatisation of the NHS.

As doctors working in England, we agree that this legislation will cause irreparable harm to the health service if passed in any form. The misguided focus on competition, and on service provision by Any Qualified Provider, will result in a fragmented and unequal service, with a loss of public accountability, and a damaging focus instead on services which are financially profitable.

Although the Bill has been presented both to the public and healthcare professionals as a “done deal”, it lacks an electoral mandate. It is being rushed through at great cost, despite the serious concerns of healthcare experts and professional bodies, and with scant regard for evidence or any provision for piloting.

We applaud and support the position adopted by the BMA Council, and call on the government to withdraw the Bill.

The issue of GP practice boundaries is creeping back into the news


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.’


The public are having to protect their institutions from the people in charge


Something has gone seriously wrong if the citizens have to protect public institutions from the people in authority whose responsibility it is to safeguard those institutions.

A most unsettling situation: the people at the frontline have to protest to the politicians & policy makers whose responsibility it is to optimise the functioning of the system. What do you do if these politicians and policy makers propose policies which undermine and dismantle the system, while telling you they are making it better?

For information on how to write to your MP, click

It’s better than having to go out and riot. I hope.

(One example, see my email exchange with ‘Andrew Lansley’)