J MEIRION THOMAS
Extra money for the NHS will be wasted because the Government won’t take on the hard-line health unions
The British Medical Association Annual Representative Meeting will take place next week, just days after the Government pledged enormous new spending on the NHS. In view of the almost universal dissatisfaction with the performance of General Practice, and in order to prove to the public that yet more taxpayer’s money won’t be wasted on services that deliver little to patients, I would suggest that an emergency motion be tabled: “This meeting recommends the radical reform of primary care.”
Of course, that will never happen because the BMA is a hard-line trade union committed only to the interests of its GP members and not to the patients they serve. They will not renegotiate the lucrative multi-layered contract that gives GPS autonomy, the right to work office hours only (often very part-time), to have no responsibility for patient care at nights or on weekends, to job-share and to delegate responsibility to transient locums, all in return for a guaranteed lucrative salary and pension.
Nor will they care about the consequences. Inevitably, GPS’ unique work pattern, a legacy of the Tony Blair governments, transfers the responsibility for urgent care to A&E, a speciality already under stress with recruitment and retention difficulties. A senior A&E consultant I visited this week explained that GP appointments in central London were now so inaccessible that patients have learnt that the only way to get urgent care is via departments such as hers. Such wholesale dereliction of duty cannot be allowed to continue.
Professor Martin Marshall, chairman of the Royal College of General Practitioners, agreed recently that primary care is not fit for purpose: “The truth is that the job of a modern GP to provide safe, effective and personalised care for patients is becoming increasingly unachievable.” His only solution, however, was 6,000 more GPS, which will never happen because the seniors are leaving in droves and juniors are reluctant to replace them.
Privatisation of general practice within the NHS is another concern. Operose Health, the UK arm of a large American healthcare insurance provider, has taken over management of 49 GP surgeries in London and another 21 surgeries out of London. This suggests that there are significant profits to be made from general practice, with the NHS footing the bill.
Most of the complaints of the GPS themselves, however, do not pass muster. Dr Samira Anane, workforce policy lead of the BMA GP Committee, recently seemed to suggest that GPS were cutting their hours to avoid burnout because of the stresses and pressures of the job. But in my 33 years as a hospital consultant surgeon I didn’t see this happen once, even in cardiac, brain or cancer doctors who take life and death decisions daily. Why should GPS be so badly affected given that they work at the opposite end of the medical complexity spectrum?
The wider problem with all the new money that the Government is committing to the NHS is that it comes without any reform, and I predict that the bureaucrats that the health service seems to be hiring, charged in part with spending the £36billion wisely, will never have worked at the bedside. I know from experience that the natural instinct of hospital managers when faced with a problem is to appoint more managers.
But the case for reform is particularly strong for primary care. The system has been irreversibly damaged because some GPS have been allowed to run it for their own convenience and not for the benefit of their patients, notwithstanding that many GPS still provide an exemplary service.
The obvious solution would cause an explosive response from the British Medical Association and the Royal College of General Practice. It is totally inappropriate that GPS should be contracted to, rather than employed by, the NHS. The system has been abused to such an extent that change must be enforced.
Like other NHS doctors, GPS should have a contract and a job description. Part-time working must be redefined, such as four full days every week. Job-sharing should be abandoned. Some responsibility for out-of-hours care must return.
Given the attitude of the health unions, the Government would have to impose this change. If the BMA wish to call a strike of GPS, I doubt that most patients would notice the difference.
A now retired GP in his 90s from Bristol who continued doing locum work until five years ago recently wrote to me: “Many GPS are using Covid-19 as an excuse for not providing good clinical services. Being able to opt out of night/weekend cover and only working two or three days a week have caused the demise of general practice to the detriment of patients.”
It is a tragedy that the Government appears content to ignore this, and instead is determined to throw good money after bad.