An extraordinary letter has appeared in The Telegraph this morning, online version here, a letter so bizarre that it elevates those chirpy Eurovision Song Contest result package links to communiqués of Kissingerian consequence. Signed by a clutch of GP chavs, it appears to be the brainchild of a scuba-diving Masonic medical wax chandler (motto: Non Angelus sed Anglus – No Angel but at least I’m English) who, tellingly, lists Conservative poiltics as one of his ‘interests’, which is putting it mildly: here he is blogging in 2009 about what the Tories are going to do to the Labour legacy once the Tories had achieved the ‘moral authority of victory’ in the 2010 election. Taken together with today’s Telegraph letter, it appears that Pimlico GP Dr Jonathon Munday’s zeal for nuking Labour legislation is matched only by an equal and opposite zeal for propping up Broken Arrow’s dud legislation.
Dr No is not going to pursue the ad hominem argument – Munday is more than able to make his own case, sitting as he does at the deeper end of the diving pool – except to underline the obvious: Munday is not so much acting here as a medical practitioner of independent mind, as a political activist who happens to be a doctor. Instead, Dr No intends to point out that the pro-Tory NHS reform Telegraph letter has holes in it the size of Saturn’s rings.
It opens with a munificently sweeping statement that hints – and indeed fools the Torygraph into believing – that the signatory GPs represent over a thousand general practices, not to mention seven million patients – over thirteen percent of England’s population. This is disingenuity on a stellar scale: the letter represents the views of the signatories, and the signatories alone; and this disingenuity sets the tone for the remainder of the letter. It continues:
‘First, the reforms are not revolutionary but an evolution and a natural conclusion of the GP commissioning role that began with fundholding in the 1990s, and, more recently, of the previous government’s agenda of GP polysystems and practice-based commissioning.’
Apart from the unfortunate effect of suggesting GPs might have more to do with filling cracks in walls (and no doubt papering over them too) than looking after patients, this sentence is in direct opposition to the truth. The reforms – dubbed by NHS Chief Exucutive, David Nicholson, who also likes to take the extra-terrestrial view, as so large that they could be ‘seen from space’ – threaten the biggest shake-up the health service has seen since it’s inception, more big bang than gentle growth. And while it is true that Labour tinkered with practice based commisioning for enthusiasts, Tory initiated fundholding died in the late 1990s because it didn’t work. The current reforms are not much a ‘natural conclusion’ of fundholding, as a thinly disguised attempt to resucitate that long dead Tory beast. A short while later we have a summary of the voluminous (currently 400+ page) Bill:
‘All that has been proposed [in the bill] is that, instead of clinicians working under the direction of bureaucrats, the balance of influence and responsibility should change.’
Now, Dr No appreciates brevity as much as the next man, but chopping 400+ pages down to twenty-four words is taking terseness beyond the point of taciturnity, and conveniently omits one or two other rather important changes – like removing the Secretary of State’s responsibility to provide a comprehensive national health service, and opening care provision to any willing/qualified provider, and the introduction and active encouragement of competition. And so it is that, once again, we see the Bill being presented as a family-doctor family-friendly what-could-be-more-sensible-than-that Bill, rather than the nuke-the-NHS blueprint it really is.
And so the letter continues. There is evidence that Munday’s original draft has been re-written, with the inevitable introduction of confusion and dilution of meaning, by committee. What for example does this really mean?
‘We caution the Coalition of the danger of confusing [sic] and diluting [sic] the responsibility for effecting change in any amendments to the current proposals. Many GP consortia already have a record of improving patient pathways. That innovation should not be constrained.’
Maybe it is just Dr No’s weak and feeble intellect, but he finds that each time he reads that last paragraph, the message becomes ever more dilute, and Dr No ever more confused…until he came across this:
If [the reforms are] successful, there will be enormous benefits to the most elderly, infirm and vulnerable people in our community, whose care is often currently too fragmented.
which is bizarre, given that the considered opinion of the majority of informed commentators – including none other than the Chair of the Royal College of General Practitioners – is that the reforms risk bringing about the opposite effects. In a statement issued earlier this year, the College said it was:
‘concerned that some of the types of choice outlined in the Government’s proposals run a risk of destabilising the NHS and causing long-term harm to patient outcomes, particularly in cases of children with disabilities, those with multiple co-morbidities and the frail and elderly.’
Far from representing mainstream GPs, the forty-five signatories to today’s Telegraph letter, drafted by a Tory activist who happens to be a GP, are minority zealots already committed to GP commissioning, and, naturally enough, they are all in favour of, and indeed prepared to speak out in favour of, the proposed reforms – and, as the saying goes, they would say that, wouldn’t they? – as indeed they are perfectly entitled to do so.
But we should not mistake the protestations of outspoken zealots for the quieter voice of the majority. Recent surveys here, here and here suggest that only a minority – roughly a quarter to one third – of all GPs believe the reforms will improve the quality of patient care. Airy allusions by Munday and his commissioning buddies to over a thousand general practices covering more than seven million patients suggests a degree of support for the reforms that simply is not there. Dr No is not impressed.
Another tour de force, Dr No, I do not think even this man could have deconstructed this tawdry manifesto in a more telling, or entertaining way? http://www.lumiere.net.nz/reader/media/images/img_rfisk1.jpg
The first question to ask each of ‘Munday’s marauders’ is – what’s in it for them?
I mean will any of them be poorer if privatisation, sorry, I meant liberation of the NHS continues?
It’s not as if both the BMA and RCN have not already raised serious concerns about the new bill?
http://www.guardian.co.uk/society/2011/mar/15/bma-meeting-rejects-nhs-reforms
http://www.rcn.org.uk/development/students/news_stories/students_show_no_confidence_in_reforms
Still, what do all these doctors and nurses know compared to letters sent to the torygraph in green ink, eh?
http://www.tigerpens.co.uk/blog/green-ink-the-colour-of-eccentrics-and-spooks/
Glory be, A and E Charge Nurse, as a junior doctor I used to write all my notes in PURPLE ink? Have you any idea what that means? Should I worry about it? Should others worry about it?
P.S I later changed to black ink and am now worried I have become a conformist!
A&E CN – thanks for your upbeat comment and I quite agree, and nearly included, so thanks for doing it, the BMA and the RCN. There has indeed been a remarkable outbreak of consensus across the professions. But there is still a large pool of rank and file who are not so much lions led by donkeys as donkeys led by asses – and read that as you will – who adopt the line that the reforms are inevitable and so we must do the best we can by them. This is defeatism on a monumental scale, and while it may have had a place on the SS Titanic, there is no reason whatsoever to assume that the SS NHS has to go the same way as the SS Titanic. What is sorely needed is more hands on deck, more hands manning the pumps, and an expressed swell of sea-bed opinion (can’t really use groundswell of grass roots since we are at sea…) that says frankly, my dear, we don’t think these reforms are worth the candle. The problem is that at the moment that isn’t happening, and instead we have the little green men writing letters in green ink – and the Torygraph swallowing their line as a Dyson gobbles dust. Dr No, as he suggested in the post, was especially irked by the Torygraph’s
‘The “most elderly, infirm and vulnerable” in society will receive “enormous benefits” from the Coalition’s controversial health reforms, a group of senior GPs who represent seven million patients declare today.’
Represent seven million patients? Come off it… Sure, Munday’s letter invites the reader to consider it so, but that is no excuse for accepting the invitation, and then adding a touch of Torygraph puff.
The reason this matters is because the story was the lead story on yesterday’s print version, and so the letter will have assumed a weight in the mind of Torygraph readers (some 1.7 million of them) that bears absolutely no relation to the facts.
PS Dr No used to use sepia ink (with an italic nib). Perhaps that means he is after all a closet brown-nose???
“who adopt the line that the reforms are inevitable and so we must do the best we can by them. This is defeatism on a monumental scale”
Not so Dr No, it’s not about “doing the best by them” but rather, keeping the good bits and renegotiating the rest so that the needy do not lose out or the the DoH rids itself of the duty to provide universal care, for example.
I was one of the first of those who raised concerns that the reforms do not add up especially with the need to save 20% of it’s expenditure too and wrote many posts on that [please check my ‘general practice label]. But for months no one took notice or the reaction was luke warm at best. As you know, in management, one has to evaluate where they stand on a daily basis when in a red zone, nobody concerned did despite the ongoing implementation of same reform at full spead! It is therefore wiser now to evaluate one’s position on the reality on the ground so that losses are minimised – however, this is my opinion, but if you still believe this bill can be completely scrapped, then although I do not myself believe this is possible or realistic, I respect your opinion too.
You’d better get yourselves and like minded collegues together and send a letter to the Telegraph refuting it. You can’t let that stand unopposed.
Julie – I think you may have talked yourself into something?
Julie – Dr No (and I suspect, JD, Dr G and WD) are all caught in what (I cannot speak for them) I call the trap of anonymity. It is a double edged sword of Excaliburian proportions; and one that, once drawn from the rock, can never be replaced.
That said, Dr No suspects far sharper identifiable minds than his are already on the case. JT has a recent excellent piece on the C4 News website, and his latest post is also excellent. Were anyone to canvas Dr No on who might organise a response, JT would naturally spring to mind.
Meanwhile Dr No will sit in his cave watching spiders and wondering whether to out himself.
Hmm,
Might have a go at sending a wee letter myself from a Scottish perspective. At the very least they need to know who David Kerr is and what he has been hired for. I’ll see what I can do. Me and my big mouth..
I think a response is required as Andrew has leapt on The Telegraph letter as a flea would to a cat stating “I welcome the appetite shown by clinicians to lead improvements in the NHS and deliver benefits for patients. … …”
It is doubtful an opposing response would receive such acclaim as Mundays and be applauded on a DH Statement by Andrew – but you never know. Well you do really.
Anna :o]
http://www.bbc.co.uk/news/uk-england-london-13379011
Watch video with Matthew and Chris of Remedy UK
Reviewing the Telegraph’s on-line letters page this morning does not reveal a rebuttal letter (yet). There are a few short letters of varying degrees of support, plus one from a whiskered frock-coated surgeon who ties his arguments in knots more sorely twisted than any suture ever tied by him in a patient’s body:
“The problem with the health service is that it is provider-driven rather than consumer-driven, with all the consequent indifference to the demands of patients.
When I joined in 1956, my hospital of 1,315 beds was governed by a board of management of 24 members consisting of the medical superintendent, the hospital secretary, representatives of senior medical staff and of the university and the matron. Morale was high. Administrators were our servants, not our masters.
Subsequently, the NHS has become more politicised. The authority of the medical staff has been intentionally undermined, leading to an extraordinary exodus of skilled doctors seeking early retirement. It is no surprise that treatment outcomes under the NHS compare less and less favourably with other countries. To reverse this, doctors must be given more control over the management of patients.”
For a moment, Dr No wondered whether Livingstone might just be our man…a combo stalking/Trojan horse to be presented to Stevie’s Listening Tank…
An excellent summary Dr No.
Sam Lister, health editor of the Times tweeted just now, in slightly miffed tones:
A big thank u for over-spun ‘GPs love reform’ story? RT @HPIAndyCowper: So. Who gets briefing of Cameron speech: SundayTimes or Telegraph?
Like lazy labour, I’m enjoying a bit of Toryself destruction from the sidelines for the moment. JT
Thanks JT. Have added abetternhs to ‘Dr No Reads…’ which I should have done ages ago!
a power hungry man who will do whatever it takes to get a knighthood and if that means acting as the gov hatchet man he will. Remember he used to advise Labour and jumped ship when he realised they could not win the election and then trashed work that he had a hand in carrying out. Watch this man carefully he has only his interests at heart not ours