NHS for Sale: Myths, Lies & Deception (12 page)
Read NHS for Sale: Myths, Lies & Deception Online
Authors: Jacky Davis,John Lister,David Wrigley
The clause was a spiteful act which demonstrated a profound contempt for previous promises about giving power to patients and doctors. Local GPs’ views were ignored by the TSA in Lewisham – while hospital consultants are effectively excluded from almost all aspects of decision-making by the new system.
It’s worth noting that passage of this legislation again relied on the Liberal Democrats, who once more trotted obediently through the government lobby to vote with the Tories. Indeed Lib Dem MP Paul Burstow put the final nail in the coffin at the last minute by withdrawing his amendment, which would have allowed local commissioners to have the final say.
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Voters must not be allowed to forget how the Liberal Democrats repeatedly betrayed the NHS between 2010 and 2015.
One of the new organisations that purports to represent CCGs is NHS Clinical Commissioners (NHSCC).
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It claims that over 85 per cent of CCGs are members and boasts that it meets regularly with NHS England, the Secretary of State for Health, DoH, Monitor, CQC, TDA, NICE and others to raise the issues that might be holding commissioners back and help to find solutions and shape national policy.
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The NHS Commissioning Assembly and NHS Clinical Commissioners work in partnership in supporting the development of the commissioning system. As the community of all commissioning leaders, the NHS Commissioning Assembly acts as the key vehicle to enable NHS England and CCGs to work together on national issues. It works on the premise that as commissioners, NHS England and CCGs, will achieve more together than apart and that collectively we should develop, share and implement solutions focused on the biggest issues where commissioners together have most impact. As the independent voice of CCGs at a national level, NHS Clinical Commissioners influences policy development and implementation and acts as a critical friend to all relevant national bodies (including NHS England and other Arms Lengths Bodies, like Monitor and NTDA [National Trust Development Authority], patient and professional representative groups and government) on CCG issues and on the environment.
By working together, the NHS Commissioning Assembly and NHS Clinical Commissioners have an opportunity to coproduce solutions which help us all work more effectively in the interests of patients.
The membership of the NHSCC Board gives a clue as to the background and agenda of the organisation. Some names crop up that have been around for a while
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and include
- Dr Shane Gordon – famous for championing the HSC Bill before Parliament’s Public Accounts Committee in 2011 and lead author of a letter in support of the Bill when it was running into trouble. His ‘leadership’ was gratefully acknowledged by Andrew Lansley in Parliament. Dr Gordon is now leading a major initiative to outsource commissioning work in his local North East Essex CCG with a single ‘lead provider’ charged with commissioning and coordinating ‘care closer to home’.
33 - Dr Michael Dixon – chair of a government friendly organisation, NHS Alliance. Former advisor to Lord Darzi.
- Dr Charles Alessi – chair of another government friendly organisation, National Association of Primary Care.
* - Dr Jonny Marshall – has trodden the corridors of power for many years and helped to found NHSCC. He was rewarded for his loyalty by being made an advisor to the NHS Commissioning Board Executive Team in 2012 ‘supporting their work on the future design of the NHS’. He was also appointed as policy director for the NHS Confederation – an organisation that receives large sums of money from the Department of Health while its democratic processes remain clouded in secrecy.
With these government friendly GPs on board the NHSCC punches above its weight with plenty of press coverage and an ability to open doors in Whitehall for conversations over NHS policy. The BMA General Practitioners Committee
should be negotiating on behalf of GPs but see that much of their representative and negotiating powers are seeping away to the NHSCC.
In other unsettling news Labour’s shadow health secretary Andy Burnham has proposed that if they win power in 2015 he will give control of commissioning to Health and Wellbeing Boards that are run by London boroughs, county and unitary councils.
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This has been met with widespread concern given the continual reduction in councils’ budgets and contribution to social care, and the failure of Health and Wellbeing Boards to establish any significant profile or independence. GPs in particular have for over 100 years been suspicious of and resisted any control over them by local councils: they are unlikely to respond any more favourably to such proposals from a Labour government.
The latest idea from the coalition government is called ‘co-commissioning’.
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NHS England is devolving more work down to already hard pressed CCGs as they realise that Local Area Teams are too short staffed to undertake their work effectively. It is proposed that CCGs will take on the day-today management of GP contracts and performance manage the payments to practices and the services they offer. GPs will have even less influence and control with co-commissioning because those who sit on a CCG would have to remove themselves from the room when any discussions take place on GP contracts and payments control. There is also a serious risk that any GPs on CCGs who performance manage their colleagues will be seen as part of the NHS system ‘doing bad things’ to general practice. This could rapidly eroded what little trust there is between GP CCG leaders and grass-roots GPs.
How did GPs in particular and medical professionals in general end up as the victims of legislation that promised so much and delivered so little? One of the most powerful and prominent organisations which Lansley managed to neutralise was the British Medical Association (BMA). The BMA is the main medical trades union, representing 147,000 of the UK’s 250,000 registered doctors, and thus had an influential role in advising doctors whether to support or oppose government ‘reforms’. Within the BMA the General Practitioners Committee (GPC) represents the UK’s 40,000 GPs.
The BMA leaders failed to recognise the dangers inherent in the Lansley Bill and wasted months when they should have been campaigning against it pursuing a policy of ‘critical engagement’. This achieved nothing apart from allowing Lansley to claim that doctors backed the reforms, a claim he repeated unchallenged up to and including the day the legislation passed.
Despite the fact that the HSC Bill contained sweeping changes, neither the British Medical Association (BMA), the main trade union representing doctors, nor its General Practitioners Committee were willing to consult English doctors about their views on the proposed changes.
Their paternalistic attitude was summed up by the then GP leader, Dr Laurence Buckman: ‘we know what they think, we don’t need to survey them’. As a result many doctors felt let down by the BMA, which failed to voice their hostility to the HSC Bill. However, surveys of GP opinion by
Pulse
magazine and by the professional body,
the Royal College of General Practitioners, showed time and again that a majority of GPs were against the Bill. Had their opposition been given public expression in a refusal to engage with the process, it would have made it extremely difficult for Lansley and Cameron to push the Bill through.
This lack of professional leadership from the BMA was compounded by the fact that much of the media, in particular the BBC, obediently regurgitated the coalition line that the legislation was about ‘giving more power to GPs and to patients’. This played into the government’s hands and allowed them to bulldoze through one of the most undemocratic Acts of recent parliamentary history with little public awareness of what the implications would be.
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There were serious concerns over the professional implications of rationing care and some GPs were anxious that the General Medical Council (GMC) might take a dim view if they refused to refer patients on to hospitals.
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West Sussex GP Jerry Luke received huge support at an annual BMA conference for his resolution calling on the General Medical Council to ‘reaffirm that commissioning GPs’ primary responsibility is to their patients, not to financial balance’. At the conference, Luke warned:
I fear that without the GMC telling us our patients have to come first – before the money – we are going to be led by some of our colleagues who are quite happy to cut and slash just like the Department of Health wants. I personally am not prepared to carry on like this. I’ve been up close and personal to the decisions CCGs have to make. They have only one real duty, and that is to end the year in budget. Everything else is secondary to that. You’ll hear from the advocates of clinical commissioning that it is outcome focused and clinically appropriate. Do not be seduced by snake oil salesmen. CCGs can run out of services, but they must not run out of money.
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Ironically at the same time that GPs were being asked to restrict hospital referrals by their CCGs they were being blamed by politicians and the national press for failing to diagnose cancer at an early stage – which almost always requires hospital investigations – and encouraged by NICE to increase their referral rates.
http://www.bbc.com/news/health-30119230
;
http://www.mirror.co.uk/news/uk-news/gps-failing-thousands-cancer-patients-2899973
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The BMA’s failures – either to consult their members or to understand the Bill – allowed Lansley to get away with his legislation. Why didn’t the BMA leaders – in particular Dr Hamish Meldrum and Dr Laurence Buckman, both GPs themselves – heed repeated calls to survey their members? Perhaps they were frightened of the answer, afraid that doctors might oppose the Bill and thus drag the BMA out of the corridors of power and make it fight for its members. Whatever the reason it was a critical mistake by the BMA and the consequences will be felt for years.
Professor Clare Gerada (then chair of the Royal College of General Practitioners – RCGP) was an exception amongst GP leaders. She was not afraid to oppose the coalition health reforms, although she later admitted that her ardent campaigning had made her ill.
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In her final keynote speech to her College she said ‘in ten years’ time, I predict, the NHS Act will be viewed as one of the historic misjudgements of all
time’.
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In 2014 the RCGP launched a clever and high profile campaigning strategy ‘Put Patients First – back general practice’.
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It focused on the recruitment and retention crisis in general practice and successfully highlighted the reduction in funding for primary care. Many commentators took notice and the campaign attracted much media coverage. Campaigning is territory that BMA used to effectively own but in recent years their GP committee seems to prefer contemplating its own navel rather than send out the message that general practice was on the verge of destruction.
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The 2010 coalition government has overseen an unprecedented collapse in morale in general practice. Dr Maureen Baker, the new leader of the Royal College of General Practitioners, warned in 2014 that general practice is on the ‘brink of extinction’.
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There have been year on year cuts in the share of NHS spending for general practice, and the RCGP estimates real terms budgets will have fallen by 17 per cent by 2017.
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Meanwhile the government, pointing to the £2.5bn a year increases to the NHS to keep pace with price inflation, claims that they have increased the NHS budget.
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In five years of flatline real terms funding, primary care, together with mental health, has suffered actual cuts.
The increasing financial pressures and unmanageable workload are causing GPs to run for the hills and retire early.
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In one 2014 survey, a shocking six out of ten GPs
were considering retiring early due to the pressures and to constant denigration of the profession.
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Norfolk based GP Dr John Harris-Hall said of his decision to retire early:
The increasing demand and workload pressure are leading to low morale and stress, causing many GPs like myself to leave the profession. I am sad to retire early but I feel there is no other choice. Enough is enough.
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Not surprisingly young doctors considering their future careers are not attracted by general practice. Consequently there is a looming recruitment crisis, and in 2014 – for the first time ever – NHS leaders were scrabbling around trying to find more doctors willing to train to become GPs. Dr Krishna Kasaraneni, former chair of the BMA’s trainee GP subcommittee, said it was unlikely that an attempt to find further recruits would dramatically improve uptake or cover the shortfall of new trainees.
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The lack of new recruits to general practice combined with the early retirement of thousands of GPs has the makings of a perfect storm in primary care, with far fewer GPs than are needed to see the patients in our communities.
In October 2014 alarm bells even began to ring for ministers and Jeremy Hunt hastily announced an independent review to establish how many GPs would be needed in the future.
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Handily for Mr Hunt the review would not report until after the 2015 general election, leading many to accuse him of kicking the issue into the long grass in order to avoid difficult questions in the run-up to polling day. The BMA welcomed the review
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but many felt it was too little too late as the profession was already on its knees.
Despite the belated review, battles over plans that would
severely cut or eliminate the special funding for some GP practices in deprived areas have again pointed up the inequality of access to GP services, which could be made worse if some of the affected practices are closed. In November 2014
Pulse
magazine published a survey suggesting that as a result of this threat one in twenty GPs were thinking of closing their practice in 2015.
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And this is happening at a time when the political pressure is to push care out into ‘the community’, resulting in more work for already beleaguered GPs. One could be forgiven for thinking that the politicians are setting primary care up to fail.
