In an open letter to the Secretary of State for Health Patricia Hewitt, Tony Blair put ‘more choice in GP services’ at the top of his agenda. So how ready are you to deliver? Probably not very, if you’re one of the 7000 or so GPs set to quit in the next 2 years.
The mass exodus of burned out fifty-something GPs has been fuelled by the new contract, which, whether by luck or design, has delivered a pension windfall making early retirement too good to resist.
Finding a replacement partner is also proving difficult. Although the number of GPs has increased in the past few years, the money has now run out and GP registrar posts are being cut and the flexible career and returner schemes have been axed.
A recent survey of GP premises by the BMA found that 59% of practices who responded stated that their premises were not suitable for their practice needs, and 75% felt that they don’t have the facilities to cope with future demands.1 Space is so tight that some practices are giving vaccinations in coffee rooms and kitchens, and less than half had the room to train future GPs.1
Despite all these problems, there are still plenty of entrepreneurial GPs out there waiting to be ‘incentivised’ to deliver more services under practice based commissioning. But instead of being offered true autonomy and power, we may just be used as a brake for payment by results, the tariff system that has sent hospital costs spiralling out of control.
As Dr Tim Richardson put it “GPs are not the slightest bit interested in becoming commercial police for the government to reduce costs, because that's what finance directors want us to do.”2
But if we don’t accept the challenge, who will? Labour’s tactic to overcome resistance in the NHS is to wheel in the private sector. This worked when the system was awash with money, but now we’re heavily in debt – private finance incentive (PFI) contracts for new hospitals are being delayed or cancelled and so are plans to build more independent sector treatment centres.
Having paid the private sector well over the odds for 9 years, the NHS can no longer afford the bills, which is hardly the best environment to encourage new entrants into the GP marketplace.
The mechanism to allow private companies into general practice – alternative provider medical services (APMS) – has been around since 2004 but hasn’t taken off. Desperate to avoid the overspends of PFI contracts, the government is forcing private companies and local NHS bidders into an absurdly convoluted and expensive tendering process. The mighty UnitedHealth Europe spent a fortune securing the contract to run two GP practices in Derby, only to be opposed by a GP and taken to court by a local resident.
The theory that areas of poor health generally also have poor GP services is true, but this should have been addressed as a priority when Labour first took office. Reforming community services when the government is in decline and the NHS is back in debt is inviting failure. And I still cling on to the old-fashioned view that cooperation in healthcare gets better results than competition.
The most optimistic doctors I have spoken to recently work in one of the Kaiser pilot sites in Birmingham, where hospitals, PCTs and GPs work together to decide where their patients should be treated, rather than fighting desperately for business.
Patients are people, rather than commodities, which is why they keep flocking for unproven but holistic complementary therapies in the face of the reductionist NHS mayhem that surrounds them.
- Harding ML. Practice-based commissioning. The paradox at the heart of practice power. Health Serv J 2006; 116: 14-15.