GPs could share profits from savings made through consortiumsBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1439 (Published 04 March 2011) Cite this as: BMJ 2011;342:d1439
All rapid responses
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
2. By and large these public institutions, like Health and Education,
are valued and loved, so simply privatising them in a transparent way is
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
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
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: No competing interests