In sickness and in wealth

18 Apr 08
VICTORIA MACDONALD | General practitioners are, on the whole, a conservative (with a small ‘c’) bunch.

General practitioners are, on the whole, a conservative (with a small ‘c’) bunch.

So it was a surprise when a group of practices in Somerset recently took out full-page advertisements in their local newspapers and put petitions to sign on their reception counters, all protesting against what they feared were government plans to privatise the family doctor service.

Ministers adamantly denied any such intention. They went so far as to stretch out their centralising arm to the hapless local primary care trust and make it put out a press release berating the GPs for creating such a public fuss.

But the seed was planted. And the GPs seemed to have a good case, pointing to the interim report on the future of the NHS by health minister Lord Darzi.

Published in October, it said there were to be 100 new GP practices and 150 GP-led health centres open 8am to 8pm, seven days a week. Crucially, from the GPs’ point of view, it added that these would all be open to tender by private companies. PCTs have already been told to start preparing contracts.

The real question, though, is why more family doctors aren’t protesting. There are pockets of objectors around the country but nothing of any great note. Yet, there is a revolution under way, spearheaded by Health Secretary Alan Johnson and devotedly enforced by his ministers, Ben Bradshaw and Darzi. From polyclinics to Tesco-run surgeries, it is all about a totally different way of running the service.

There is no doubt that Johnson will not want the word ‘privatisation’, bandied about too much in this the year of the sixtieth anniversary of the formation of the NHS. He has, nevertheless, not pulled his punches in saying that he wants changes and GPs are going to have to go along with him whether they like it or not.

He is like a less pugnacious but equally stubborn Kenneth Clarke, who most notably introduced GP fundholding at the beginning of the 1990s. It might be worth noting, for students of history, that that was the last time doctors did rise up in protest and, in that case, won.

However, Johnson and the prime minister have already scored a victory in the row with the British Medical Association over longer opening hours. They forced it to cave in despite the government’s own public opinion survey, which showed that the vast majority of patients were happy with the current opening hours.

The BMA badly handled the arguments which, in the end, basically amounted to a difference of opinion over one hour.

Admittedly, they were hampered by the complex way in which GPs are paid and it was true that if they had not acceded to the government's demands they would have lost out financially.

But their problem was the range of reports saying they had received massive pay rises for doing less work. It was a hard one to spin and, in the end, they gave in gracelessly.

Now Johnson pushes on. Only last week, the Guardian revealed that NHS GPs who work at new Virgin health centres will be given 10% of the profits made by the private dentists, therapists and laser-eye surgeons working under the same roof. Under General Medical Council rules the GPs will not, of course, be allowed to refer their NHS patients to the private practitioners unless they make it clear that they have a financial stake. How this requirement will be policed has not been explained.

Meanwhile, a pilot scheme is being set up in Birmingham and Sandwell that involves moving doctors into ‘one-stop shops’ serving up to 20,000 patients, run under a sort of franchise scheme. A PCT document on the corporate franchise strategy said: ‘There is growing interest in primary care as a future market from a number of non-health organisations who are convinced they can be effective and efficient suppliers of these services in terms of both quality and cost.’

After an outcry, the PCT said that only local doctors would be considered for this franchise scheme. However, the idea is out there and it fits nicely with the supermarket model and the polyclinics.

GPs are businessmen and businesswomen and can technically compete in this market. However, in the cases where it has been opened up to competition — for example, in Camden and Tower Hamlets in London — the private companies have won the bid without substantive evidence that they can provide any better service than the local family doctors who had also competed for the contract. This leads to the suspicion that the PCTs in charge of awarding the contract are going where they believe the government wants them to go.

The BMA said the Virgin health centres scheme could be opening a Pandora’s box. Many would say that the box has already been opened and Johnson seems well aware that once it is open it will be almost impossible to close.

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