GPs back withdrawal of health reform billBMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e391 (Published 13 January 2012) Cite this as: BMJ 2012;344:e391
All rapid responses
Pity the blind men who find an elephant and from their different perspectives each is convinced that they have the correct interpretation of this new object. If the elephant is incomprehensible to a blind man what hope is there for the GP seeking to understand the NHS reforms?
98% of GPs are widely reported as opposing the health bill but this is misrepresenting the data . The figure is based on responses to an e-mailed news update to which 2600 out of 44 000 GPs responded. An equally valid interpretation is that 93% of GPs are either too busy to read e-mails from the RCGP or see too much complexity to provide headline responses. Whilst the first explanation may well be true I think there the second is also valid. At our CCG meeting last week where all 18 practices were represented by two members each there was only one vote for outright opposition to the bill. However, this did not mean the remaining 94% were blind supporters of the reforms. The prevailing view was one of acknowledgement of limited understanding but despite this a preparedness to continue towards authorisation as a CCG. Was this irresponsible or realistic?
The great majority of GPs want to provide a good service for their patients. The part of the elephant that is in front of them is their own accessibility to patients, the primary secondary care interface and the amount of manpower and financial resources in the NHS. That is a fairly big part of the elephant. Commissioning is not just service redesign but it is also about improving service delivery. The quality of primary care is also critical to service efficiency. The proposed reforms provide levers to engage with these challenges in a way that previous incarnations of commissioning failed to do, the most recent being famously pronounced as a corpse not fit for resuscitation . The reason for being open minded about these reforms is that despite the concerted opposition there are no credible alternatives being proposed. The current RCGP and BMA proposals for commissioning groups of over 1 million patients is not going to foster local responsibility for quality of service or effective local health and social partnerships. The BMAs opportunistic call for CCG groups to have a choice of commissioning support places the current PCT staff immediately in jeopardy. To argue as Professor Mackee does that change is not needed because the system is performing well by international standards fails to engage with the challenge that a fundamental cultural shift from reactive to proactive care is required if we are to provide sustainable healthcare in the 21st century. The privatisation debate is ideological and should instead be about achieving the best outcomes as a recent paper in the BMJ comparing a commercial weight loss service with a GP based service did.
CareFirst Clinical Commissioning Group
Competing interests: GP Chair of CCG