It is well known in Whitehall that the trade union with the toughest negotiators and the strongest industrial muscle is not Unison or Unite, but the British Medical Association. The BMA has done over successive health secretaries, and wrung pay deals from them for which Dave Prentis would give his right arm. The GPs are the least ‘public’ part of the public NHS. As the last outpost of opposition to the NHS in 1946, they were enticed into the NHS by being promised that they could carry on as private small businesses, which in effect is what they still are. They refused to become ‘state employees’ in 1946, and they’ve successfully stayed that way. The GPs have resisted attempts since 1948 to get more GP surgeries into poor neighbourhoods. If you are poor in Britain, you get a poorer service from the NHS, with less time spent in consultations, and fewer doctors per head of population, than if you are rich. That’s one reason why the rich live longer, healthier, happier lives than the poor in Britain today. They’ve refused to open in the evenings and at weekends. They earn a lot more (public) money than MPs.
If another network of small businesses, let’s say the federation of newsagents, was about to be handed £80 billion of public money from the treasury, and told to spend it how they liked, there might be a little concern. By announcing that the £80 billion NHS budget is about to be handed to GPs to spend on local health services, and that primary care trusts (PCTs) and strategic health authorities (SHAs) are going to be abolished, health secretary Andrew Lansley is taking a gamble on the healthcare of every NHS patient.
The white paper is out next week. All we have to go on are the pre-launch leaks to the Daily Telegraph. You can tell when the Tories are in charge because the Telegraph get government white papers before parliament does; it’s one of those rules of politics. Not being a senior department of health civil servant, or a hack on the Telegraph, I have not read Lansley’s white paper. It might be there are safeguards and checks and balances. It might be an elegant scheme, carefully worked out in every detail.
All I have to go on is the coalition agreement, the bedrock of this government’s agenda for the next five years.
The agreement states:
‘We will stop the top-down reorganisations of the NHS that have got in the way of patient care.’
If abolishing Primary Care Trusts, Strategic Health Authorities, sacking thousands of staff, and coercing doctors to become NHS commissioners, through an edict from Richmond House, isn’t a ‘top-down reorganisation’ then what is? It’s hardly organic, incremental change driven from the bottom up, is it Mr Lansley?
The coalition agreement then says:
‘The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs. It will also take responsibility for improving public health for people in their area, working closely with the local authority and other local organisations.’
Yet the trails in the media today suggest that PCTs will be abolished. It’s not a minor point. The PCTs are the central part of the NHS fabric. Their abolition would be NHS reform on a scale unattempted for decades. The NHS just got highly political once again.
Do the Liberal Democrats know that Lansley is trampling all over the agreement? If the Tories can tear it up and do what they like now, imagine how worthless it will be in two or three years’ time.
The document also states: ‘We will renegotiate the GP contract…’. Well, as my former department of health colleague Liz Kendall MP has tweeted this morning ‘good luck with that…’. Andrew Lansley wants doctors to open for more hours, be present in the toughest estates and neighbourhoods, and take on responsibility for £8 billion of NHS spending, on top of their current roles and responsibilities. If you were a BMA negotiator, can you imagine the kind of gold-plated, diamond-encrusted pay deal you would want from the secretary of state? You would walk into those negotiations with all the cards, and not leave until you’d screwed the department of health negotiators to the floor.
Andrew Lansley spent six years in opposition as shadow health secretary cooking up this scheme. He spoke at endless NHS conferences including the BMA. They were probably very nice to him. His relationship in opposition with the healthcare bodies was probably very productive. He’s about to discover that relationships in government are somewhat different. He’s about to enter a whole new world of pain.
Could erode community involvement in the shape of the NHS: http://stiveslibdems.com/andrew-george-mp/community-must-have-bigger-say-in-nhs-reforms-andrew-george-mp/
They earn a lot more (public) money than MPs. Perhaps that’s because they are of more use. In fact, lollipop ladies are of more practical use than most of the lobby-fodder that guzzles away in Westminster.
Don’t forget GPs’ minimum income guarantee and the fact that they will be providers and commissioners of care, a state of affairs that PCTs were forced to end when they found themselves in that position. Where is the accountability? Andrew Lansley is married to a GP, no doubt one who is willing and able to take on the commissioning role, but many aren’t and don’t want to. Presumably GPs will then employ ex PCT staff to do it for them. His reception at the recent NHS Confederation conference was lukewarm to say the least. He was better received in opposition!
Not so sure about the Telegraph having an inside track on coalition plans. It seems that Andrew Lansley is no shrinking violet either when it comes to spelling out his true intentions for the NHS. A speech he gave on the day of budget starkly disclosed Government plans for the NHS. See http://www.ft.com/cms/s/0/0c0b9b0c-7fb8-11df-91b4-00144feabdc0,dwp_uuid=aec5dfd0-681e-11df-a52f-00144feab49a.html From the FT piece; ‘Mr Lansley acknowledged … that his plans will involve “far reaching” changes to both the form and function of the NHS – in spite of previous pledges from the health secretary and David Cameron, the prime minister, to avoid large structural upheavals.’ ie more broken promises. Paul is right though and it seems that Harriet Harman’s description of a Lib Dem was far too flattering. The Lib Dem fig leaf is just kindling for a bonfire beneath a major tenant of health policy?
Thank you Pail Richards for spelling out that GPs are in a business that trades in Healthcare and are represented by the most successful Union of all. PCTs have failed to manage GPs, how could they be expected to with such powerful forces arrayed against? PCTs have never been able to stand up to GPs and have placated every whim. Now, in a throwback to Fundholding, GPs are to be given our chequebook and left to fill in the amounts themselves! There may be an issue with some though: GPs are going to be “forced” to accept the additional duty to decide which services the local population are in need of. Some will refuse. There are quite a few socialist GPs, but not enough to make a difference. Paul Richards should keep this insight up to date with future reports.
I am very concerned about this proposal. Most of my GPs over the years have been pleasant, but rather bumbling people. Just because they are well trained at fixing my dodgy knees and colds does not mean they are any good at procurement, hiring and firing staff etc. The BMA have complained endlessly about bureaucracy, but surely this heap a load more onto them. If they want to avoid this, they will hire Business Managers. If you add up all the costs of each practice having its own Business Managers, it will be much more than correctly set up centralised functions currently performed by the PCTs. If you take into account the procurement inefficiency that will follow, that will cost more too. I think that the health service is vastly complicated and expensive, and it needs professional management for non-clinical functions. Having Doctors run the NHS budget from practice to practice will in my opinion be a disaster for both users and the tax payer.
“Do the Liberal Democrats know that Lansley is trampling all over the agreement? If the Tories can tear it up and do what they like now, imagine how worthless it will be in two or three years’ time.” The Liberal Democrats have always been in favour of abolishing PCTs; the early indications of what the White Paper contains have LibDem hallmarks all the way through. As I see it, this proposed action is hugely wasteful; has Lansley calculated how much the redundancy payments will cost?! These same individuals (myself included) are likely to find themselves in similar roles employed by a locally elected health board a year or two down the line.
The Tories are following the recommendations of the Marmot Review which was conducted during Labour’s term in office. It builds on Labour’s policy of making GPs the gatekeepers of the system and makes clusters of GPs co-operate in local “polysystems” where GPs specialise in different things and send patients to each other. Whether it creates less beaurocracy is another thing. This is likely only to happen when waiting lists have ended and providers have to compete with each other. The new system would have been implemented by a Labour government. The really big reforms were under Blair and the Tory government before him. This system is much more NHS led rather than politician led.
It is not £8bn it is £80bn. You are out by a factor of TEN. Yes it is that bad. In my area GPs get 9% of the budget (4.5% for GP practices, 4.5% for other GP services) hospitals get 49%. The GPs are clearly the underdogs when it comes to handing out the money. The hospitals are public bodies and have public Board of Directors meetings and public Foundation Trust Council of Governors meetings. The public CAN get involved in how hospitals spend public money. GPs will now have control over all the money spent on hospitals. I will leave it up to you to predict if hospital budgets will remain at their current levels. But bear in mind that the public have no right to attend GP practice management meetings when they decide how they spend taxpayers money. Democracy and public scrutability is being sacrificed for the sake of Conservative ideology.