Tories claim that GPs support their NHS plans, but doctors oppose them as strongly as nurses do
Unsurprisingly Andrew Lansley received a vote of no confidence from the Royal College of Nursing on Wednesday. Making what are essentially policy issues overly personal, while often politically effective, is perhaps not the most appropriate way of engaging with those you are seeking to negotiate with – which was why the British Medical Association, which feels as strongly as the RCN, resisted passing such a motion at its recent conference.
However, in addition to his welcome assertion today that substantial changes would be made to the health bill, Lansley demonstrated why healthcare professionals are so frustrated and antagonised. He sabotaged his diplomacy by parroting the usual guff about clinical support for his plans.
The only thing to say in defence of his statement that "90% of GPs' surgeries across the country have stepped forward and said we want to be pathfinders" is that at least he didn't claim – as he and colleagues have done – that 90% of GPs support the plans. This is patently untrue, since according to a survey for the Royal College of GPs barely 30% agree that the expanded model of GP commissioning can improve healthcare outcomes, and a mere 20% of GPs think the plans as a whole will result in better care. The BMA meeting I attended last month saw 90% of the doctors' representatives voting against them.
And it is not clear that 90% of practices have signed up, or if it is merely sufficient practices to cover 90% of the country. (It's even less clear whether that's by population or geography.) The Health Service Journal's map of GP commissioning shows plenty of gaps. In any event just because you show a willingness to participate in a proposed system doesn't mean you approve of getting rid of the old one. This idea was put succinctly by Dr Laurence Buckman, chairman of the BMA's GPs committee: "Having a large number of GPs signed up to consortiums doesn't prove they are in favour of the reforms. Just because someone gets into a lifeboat doesn't mean they support the sinking of the ship."
In fact, the opposite may apply; those GPs most concerned about their capacity to commission may wisely be opting to obtain training and support at the earliest opportunity, battening down the hatches to await the imminent storm.
Further undermining Lansley's case, primary care trusts have received instructions (possibly in the same envelope as their P45s) that they must corral their GP practices into these shadow consortiums. Many GPs have said that they were either merely given a document to sign by the PCT for their commissioning consortium to be established or were not consulted at all.
Finally, the most contentious part of the reforms is not GP commissioning care or even scrapping PCTs. The further marketisation of the NHS is far more objectionable and objected to by the vast majority of GPs, just as they did the private sector encroachments of Alan Milburn, John Reid and Patricia Hewitt.
There are more fundamental problems here. You can't sell dodgy reforms to the public on the basis of identifying a bunch of professionals whom you can cajole, bribe or otherwise persuade to approve of your plans, if the plans themselves are ideologically unacceptable. And neither the public nor the profession will give you much credence if you seek to justify the proposals on a raft of dodgy statistics. The government has refused to trial these plans, while rightly requiring that new medical procedures are fully tested before being used.
Alan Milburn is reported to have said, after Labour's NHS reforms (don't ask which ones) that involved the private sector, that all GPs would soon be performing above average. Lansley's claims of GP enthusiasm for his reforms are about as credible as Milburn's – possibly apocryphal – grasp of statistics.