Doctors’ leaders who oppose the creation of GP “super-surgeries” are echoing
their predecessors who likened the establishment of the NHS to Nazi Germany,
Alan Johnson says today.
The Health Secretary launches an attack on the British Medical Association and
the Conservative Party, accusing them of reprising their “infamous double
act” when they opposed the health service 60 years ago.
In an interview with The Times Mr Johnson indicated that he is
preparing to change funding rules this month to make it harder for
single-handed GP practices to survive. He accuses David Cameron of a
political gaffe in siding with GPs’ leaders against reforms that, he says,
will improve access to doctors, particularly in poorer areas, and allow them
to provide better care.
The Government is braced for a battle with both the BMA and the Tories, who
say that 1,700 GP surgeries may have to close as a result of the drive to
group family doctors into new super-surgeries. The BMA will intensify
efforts this week to mobilise patients to oppose the changes with a planned
march on Parliament. Critics say that the centres, some of which will be run
by companies, may be more expensive, less efficient and force patients to
travel farther. But Mr Johnson justifies the reforms, saying that they would
reduce health inequalities and increase the ability of the NHS to screen for
disease, as well as increase patients’ choice and access while reducing
pressure on hospitals.
“This is all additional capacity, it’s additional money, it’s not closing a
single GP surgery anywhere in the country. We will not be railroading
patients to go to these centres,” he insists. He says there is confusion
between polyclinics - health centres designed to bring a wide range of hospital
services closer to communities - and GP-led health centres, or
super-surgeries. The former were recommended by Lord Darzi of Denham in his
review of London healthcare. Mr Johnson said he welcomed a report by the
King’s Fund, the health think-tank, that said the polyclinic model should
not be imposed in the rest of the country. The imposition of super-surgeries
is a direct threat to existing services, particularly single-handed
practices, however. And while Mr Johnson insists GPs are still in control he
confirms he is preparing to remove a payment - the minimum practice income
guarantee (MPIG) - designed to protect GPs operating alone. “MPIG is a
barrier to all sorts of things we want to do,” Mr Johnson says.
He accuses his opponents of scare-mongering when they suggest that it could
lead to mass closures. “The ludicrous misrepresentation of this policy by
the BMA and the Conservative Party is a faint echo of their infamous double
act 60 years ago when they opposed the creation of the NHS itself,” he will
say in a speech today.
Speaking before his address to the IPPR think-tank, Mr Johnson says that he is
struck by the similarity of some of the criticisms, particularly the charge
that the Attlee Government wanted to make all doctors employees of the
state. “There’s a quote from the then leader of the BMA who said: ‘I’ve
looked at this very carefully and it reminds me of national socialism as
practised in Germany.’”
In an interview with The Times in April Mr Cameron accused the
Government of trying to abolish “the family doctor service”. “Communities
which have lost their post office, their local shops and their local police
station, are now going to lose their doctor,” he said.
But Mr Johnson says that the Tory leader has made a “huge political gaffe” in
siding with the “producer interest”. “We’ve got world-class primary care but
the levels of patients who express concerns about access is large and is
growing all the time.”
Laurence Buckman, chairman of the BMA’s GP committee, said that he “did not
want to rise” to some of Mr Johnson’s direct criticisms of the BMA,
but added: “This Government has thrown away the goodwill and trust of 45,000
doctors, which now they will never get back.”
He said that the association was not against phasing out the MPIG in
principle, but gave warning that as many as one in ten practices could close
if the Government did not provide alternative funding arrangements.
“Just over 90 per cent of practices receive some income from the MPIG, and
their dependency varies, but without it about 10 per cent of practices will
be financially nonviable,” he said. “There’s a fairly even distribution of
these, which doesn’t just affect one particular group of doctors or
patients, so practices will close in rather arbitrary fashion all over the
country.”
Dr Buckman added that it was likely that “a few hundred” small practices would
have to close as a result of having to merge into or compete with larger
polyclinics or health centres.
“No one but the Government has pushed for these reforms, which have puzzled
patients and GPs alike,” he added. “It will destabilise the system
unnecessarily and seems to be an enormous waste of taxpayers’ money.”
Nick Goodwin, from the King’s Fund think-tank, said: “Primary care trusts must
ensure contracts are water-tight and ensure no patient groups or conditions
become excluded in the drive for profits. If we are going to bring in
private companies, regulation and accreditation needs to be spot on,
otherwise they will take us to the cleaners.”
What patients can expect
Nationally
— 100 new GP surgeries
— 150 GP-led health centres to open outside London
— Local consultations on future of some maternity and accident and
emergency (A&E) wards
— Every town in England encouraged to bid for up to £5 million to become
a “healthy town” featuring more cycle lanes, walking and healthy-eating
schemes
North West
— Improve average life expectancy to reach 76.8 years for men and 81
years for women by 2010
— “Children’s trusts” to plan services for children and young people
— Ten “touchstone tests” for the public, with results published online
South West
— Match the highest life expectancy in Europe - 78.5 years for men, 83.6
years for women by 2013 and the lowest death rates from cancer, heart
disease and stroke
— Achieve the highest levels of fruit and vegetable consumption in
England
— Complete 90 per cent of diagnostic tests within two weeks by 2011
East Midlands
— At least two specialist heart attack centres and four specialist
stroke treatment centres
— Stratification of hospitals into “local”, “specialist”
— Possible virtual wards" to replicate hospital care in people's
homes
South Central
— Every visit to a doctor to cover prevention as well as treatment
— At least four midwife-led maternity units may close
— Public to help to decide priorities - possibly resulting in
“legitimate geographical variations” in care
West Midlands
— “Some” specialist emergency services such as stroke and heart attacks
concentrated into key emergency departments
— Care co-ordinators to guide people with long-term conditions through
the system, plus early detection and support for dementia
— Efforts to reduce 40,000 preventible errors in hospitals every year
East of England
— Maximum 18-week wait for services including mental health, speech
therapy, podiatry, orthotics and orthodontics
— Urgent-care centres, managed by GPs, to take pressure off A&E
units. NHS primary dental services available to all who need them
— Five standalone midwife units under threat
South East Coast
— No avoidable healthcare-acquired infections, such as MRSA, by 2018
— Specialist treatment centres for strokes, heart attacks and major
injuries by 2010, with diagnostic tests available on the high street
— Improve average life expectancy to 78.6 years for men and 82.5 years
for women
Yorks and Humber
— Improve life expectancy in areas where “significantly below national
average”
— Halve the number of children admitted to hospital with asthma
— Prevent 600 premature deaths every year with better stroke care
— Improve services so that terminally-ill patients who wish to die at
home can do so
North East
— Personal health plans for everyone at high risk of suffering
ill-health, to be achieved by January
— Maternity services to be reviewed to provide one-to-one midwifery care
— A single telephone number for accessing urgent health and social care
services
London
— At least 100 doctors surgeries to merge to form polyclinics
— Some local accident and emergency or maternity services likely to be
merged or closed
— At least three large “super-hospitals” with dedicated trauma units to
treat patients in the event of serious accidents or terrorist attacks
Sources: NHS; Conservative Party; Health Service Journal
