Helen Salisbury: Primary care networks—cause for celebration or concern?BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l973 (Published 05 March 2019) Cite this as: BMJ 2019;364:l973
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Helen Salisbury is trying to prod the optimist into life about the 2019 GP contract but examination of the detail should produce nothing but pessimism (BMJ 2019;364:1973).
As is clearly stated in the document Investment and Evolution signed by the BMA GPC England chair and NHS England Primary Care Networks are the building blocks of every Integrated Care System (ICS) which are to be the new form of healthcare provision in England by 2021.
ICSs are the direct descendants of the American Health Maintenance Organisations (HMO)and Accountable Care Organisations (ACO). President Nixon first introduced HMOs when told the less care they give the more money they make. Alan Milburn was seduced by Kaiser Permanente on false data and a subsequently discredited paper. He started the drive towards HMOs with the prerequisite changes to general practice. ICSs will decide what and how much care is provided to set populations and in the commercial ventures share profits with commissioners. Their aim is to achieve lower capital cost of care.
GPs are being seduced by the headlines of more money and staff. They would be naïve to think the money is to help them with their current heavy workload. It is conditional on additional work. More worrying is the loss of autonomy. The other staff are to be asked to do doctors’ work at great risk to the patient. The link between doctor and patient is to be further stretched till it breaks completely. Local surgeries will disappear and see the end of traditional family practice and continuity of care. This too is a necessary step so that ICSs can function efficiently, and not to the benefit of our patients. The final step is to convert ICSs to the American-style insurance system.
These changes are being rushed through in the hope that hardworking GPs at the coal-face who have no energy left to resist give in to the immense pressure to sign up.
Other GP contracts have been put to the vote after debate. The BMA GPC chair has signed a document that blames the current GP crisis on the complexity and increased numbers of patients and the commitment to work of GPs without an honest acknowledgement of the dramatic cuts in funding. That sets the tone.
The 2019 contract should be subjected to the same scrutiny and rejected by the profession.
Dr Paul J. Hobday
Competing interests: No competing interests