Sunday, April 21, 2019

NHS crisis: GPs to be packaged for sale and side-lined

 Dr Bob Gill, Anne Athow, Frances Hook and Dr Paul Hobday.

By Daphne Liddle

THREE campaigning doctors warned that imminent changes to the way general practitioner (GP) surgeries are organised threaten to destroy the traditional relationship between family doctors and their patients, and to package primary healthcare in this country ready for sale to giant corporations.
Retired GP Dr Paul Hobday, current GP Dr Bob Gill and retired surgeon Anne Athow were addressing a packed meeting last Friday evening in a community hall in Eltham, south London, organised by Greenwich Keep Our NHS Public.
GPs are currently being pressured to sign a new contract committing them to the new ‘NHS Long-Term Plan’, which sounds wonderful at first sight: all GP practices within a locality joining together with other health providers – dentists, pharmacists, podiatrists, mental health care providers, volunteer health workers and so on – to work together as a team to provide the best possible care for everyone living in that locality and using the latest new technology to do so.
These groupings will be called Primary Care Networks (PCNs), to become the vehicles for a ‘Directed Enhanced Service’ (DES). The word ‘directed’ gives a clue as to the real role of these giant bodies that will be responsible for the healthcare of up to 80,000 members of the public.
And the general direction, as dictated from above, will be to reduce drastically the numbers of hospital admissions, of visits to Accident and Emergency (A&E) units and to replace the role of doctors with a plethora of less qualified people.
People will no longer have a named GP they are registered with – already people are logged as being registered to a group practice rather than an individual doctor. Under the new plan, when someone is ill their first call will be answered by someone who does not know them, who has few if any medical skills and who will them re-direct the call to the ‘specialist’ they deem most appropriate. This could be a pharmacist, a nurse practitioner or a voluntary body such as Mind.
Only very serious and complicated cases will get through to real, qualified doctors – and then it will be a doctor they do not know and who does not know them. Their notes and case history will be available to the doctors but they will not have time to read them. Most of these interviews with patients will take place on Skype.
In fact, all the data about all the patients will be available to an army of strangers – including advertising and insurance companies.
Some patients will be expected to diagnose themselves using on-line questionnaires and then take the computer programme’s advice on caring for themselves.
Meanwhile the PCNs will operate ‘shared savings schemes’ that will allow doctors to benefit financially from reduced A&E admissions, attendances and other hospital admissions, and early unsafe discharges, as well as major cuts to outpatient appointments.
The contracts for joining the PCNs are currently being dished out by the current Clinical Commissioning Groups (CCGs) and GP practices have until 15th May to sign them – effectively signing themselves into redundancy. But even if they do not sign, their patient lists with all the data will be transferred to the new PCNs anyway. Practices will lose control of their budgets to the PCNs, which will become embryonic American-style integrated health companies ready for quick privatisation.
Anne Athow displays the document
The priority concern of these companies – and imposed on all their staff – will not the patients but the economic well-being of the company.
Doctors are under heavy pressure to sign these contracts and few have time to study the contents. Even fewer patients are aware of the impending changes.
Regrettably the British Medical Association (BMA) has endorsed the plans without a debate or vote on the issue. Other health unions have failed to raise a campaign against them, even though their members will find themselves downgraded, more exploited and often expected to make medical judgements beyond their training and competence and then carry the can for mistakes.
Dr Paul Hobday spoke of the early days of the NHS before the preparation for privatisation began in the late 1980s and ‘90s. GPs used to visit patients at home; they very rarely sent people to hospital but when they did, they sent them straight to the appropriate consultant – and knew which consultants NOT to send them to.
There were no long waits in A&E (Casualty, then) to be assessed by junior doctors who knew a lot less than the GPs about what that patient needed. There were no financial pressures then, the needs of the patient were the only priority.
In those days admin accounted for about four per cent of the NHS budget, compared with 17 per cent now; and the NHS was all about co-operation, not competition.
He described the current “salami slicing” of the NHS to the private sector and the growing demoralisation amongst health workers.
Under the new five-year plan GPs will no longer be able to be advocates for their patients, patients will have to travel further for treatments to anonymous hubs.
“The affluent will jump ship,” he said. He warned that the private sector will be out to milk those patients who can afford it – prescribing unnecessary but lucrative treatments, but “no cure for those who can’t afford it”.
He also warned that: “This is not a cock-up; it’s a plan.”
Anne Athow took the meeting through the documents the GPs are being pressured to sign, warning that this was part of the capitalist system and the only real answer is to get rid of that system.
Dr Bob Gill spoke of the effects of the downgrading of the Queens Mary Hospital near his GP practice. The hospital lost its maternity and A&E units, sold off for luxury housing development to resolve huge debts caused by PFI [private finance initiative]. He said this caused difficulty in referring his patients to hospitals within reasonable travelling distance.
He warned that the new plans would set up conflicts and rivalries amongst GP practices and hospitals trusts – based on money, not the best interests of the patients.
All the speakers urged the audience to contact their own GPs and warn against signing the documents and raising awareness of the impending changes generally.
But in discussion afterwards the speakers said that there was little optimism about achieving an effective campaign in the short time available.
One speaker from the floor suggested campaigning within the Labour Party and directly with Jeremy Corbyn to get the party to commit to reverse these changes once Labour is in power. This in itself would act as a deterrence to the giant companies hovering like vultures over the NHS and its GP practices.

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