Labour seems to be watering down promise to abolish PFI

Deselecting GPs

Another story that appeared in the margins of coverage of the Labour conference was spotted by the Guardian’s political correspondent and mainstay of the newspaper’s live blog Andrew Sparrow in trailing Labour leader Jeremy Corbyn’s speech,9 in a section on the theme of making public services more accountable to their communities.

In the final version of his speech Corbyn told the conference, “The kind of democracy that we should be aiming for is one where people have a continuing say in how society is run, how their workplace is run, how their local schools or hospitals are run. That means increasing the public accountability and democratisation of local services.”10

Sparrow reported that “one idea being kicked around informally by Labour MPs would be to enable patients to somehow vote out GPs if they feel they are getting a bad service.”

Clearly, this was and is not official party policy. Just as clearly, it’s an important insight into the thinking within the Labour Party of 2017. That a Corbynite Labour Party would be keen on deselection of MPs is scarcely surprising: to consider deselection of GPs is another matter altogether.

So many aspects of this idea are bad and silly, it’s hard to know where to start. In the first place, there is a significant shortage of GPs at present: NHS England reckons at least 5000.11 So, the alternative providers who could come in and take over from an unsatisfactory incumbent don’t actually exist, unless the Corbynistas have found the magical medical tree where experienced clinical staff grow for free.

Then there is the issue of the premises, which most GPs working under general medical services (GMS) contracts tend to own. It wouldn’t be possible for a future Labour government to pursue this policy without expropriating massive amounts of private property. That would be highly expensive in compensation and open to vigorous legal challenge.

Were the local community to be offered the chance to electorally deselect its GPs, would the criteria the public use be sensible ones? What would be the fate of a general practice that had a robust policy on antibiotic prescribing? Would we go full-on reality television and have a weekly diagnose-off between the bottom two practices?

Finally, there is the issue of the N in NHS—the national bit. As the experienced public policy observer Nicholas Timmins pointed out recently,12 the public really hates postcode lotteries. Timmins cites an observation by Tony Travers, professor of local government at the London School of Economics, that “if you ask the British electorate if they want more local control, the answer is almost always yes, but that goes with an almost Reithian belief in shared standards and equity. These two desires are almost impossible to deliver in tandem; more local control will almost inevitably lead to more variation.”