GPs could share profits from savings made through consortiums

BMJ 2011; 342 doi: (Published 4 March 2011)
Cite this as: BMJ 2011;342:d1439

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8 March 2011

Open Letter to GPs

We are facing a momentous upheaval. Many of us have worked for decades in the NHS, but the landscape that we know, love and are rightly proud of is about to be bulldozed beyond recognition. Do not underestimate the scale of the changes. A Tsunami is about to hit.

But why? What is the reason? Is it really about clearing national debt and efficiency?

I do not believe so. Do we need to economise? Yes, but is a total restructure of the NHS the way to achieve this? No. And is the NHS really so expensive and inefficient? The graph below shows that compared to other developed nations, as a percentage of GDP, the cost of UK health care is actually at the lower end of the spectrum.

No, the forces that are about to be unleashed are at the vanguard of a brave new corporate world. One by one our institutions that have taken decades to develop will be eviscerated. And the speed is astonishing. Our current government is unlikely to last beyond one term due to the anger that will be created. So, to impose their ideology, they have to act very fast, whilst we are all too shocked to react.

1. Large public institutions represent a lost opportunity for corporate profit.

2. By and large these public institutions, like Health and Education, are valued and loved, so simply privatising them in a transparent way is political suicide.

3. So we have a new model: The public institution apparently remains intact but actually becomes nothing more than an empty shell that commissions services from private corporations.

4. At a stroke the thorny issues of working conditions, salaries and public sector pensions are solved by handing it all over to private corporations. The 'Global Health Care Corporation' maximizes profit by squeezing quality and reducing the workforce expense (at the cost of pay and conditions). This is the model that is being followed all over the world

5. We are sold the story that the competition created by the new model will reduce costs and increase quality, but it is not true. Bigger and bigger multi-national corporations will take over our services so that the monopoly of the public sector is simply replaced by the monopoly of huge private corporations that exist for only one reason - PROFIT. Corporations actually have a legal obligation to maximise profit.

6. Corporations are protected by competition law. They are less accountable. And once they are in, we can't get rid of them. Profits are salted away in offshore tax havens, not used for services. We have seen it all before.

GPs are being hoodwinked by the apparent offer of the reins of power, but it's becoming clear that we don't believe it. The phrase 'poisoned chalice' is being used alot. And be warned, even if amendments to the Health Bill are introduced, they will be over ridden in the future. We must reject it. The principles on which it is based are wrong.

And don't rely on the Liberal Democrats doing a U-Turn and voting against the government on the Health Bill. They can't. If they did, it would probably precipitate an early general election in which they would simply disappear. Look at the recent by-election in Barnsley.

There is growing recognition and opposition to what is happening. The Governor of the Bank of England, Mervyn King, is being bravely outspoken against the institutionalised greed of the Banks and calling for changes in the rules. Top military leaders have written an open letter to David Cameron asking him to reopen the Strategic Defence and Security Review.

We need all doctors' bodies, like the BMA, to unequivocally express their complete opposition to the Health Bill.

We need a show of social democracy. We need to be more French! Predictably, there are laws that make it illegal to coordinate industrial action between public sector employees, but we can demonstrate our opposition peacefully. I dream of one million people marching through London together. Let's express ourselves!

Dr Simon Moore GP, North London.

Competing interests: None declared

Simon Moore, Salaried GP

Crouch Hall Road Surgery N8 8HG

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