The Tories, it seems, have the hots for Big Bangs. In 1986, they famously blew open the Stock Market, deregulating the financial markets, arguably paving the way to a rather different kind of bang, more crash-bang than Big Bang, twenty one years later. Today’s Tory Big Bang target is none other than our National Health Service. Agent Lansley has been charged with blowing it to smithereens. Even before the debris settles, any willing cowboy will be welcomed to ride off with rich pickings, the drear and dross discarded, as dust on the desert floor.
The trouble facing any government that wants to put an H-bomb at the heart of the NHS is that the rest of us rather like our NHS. Sure it has its faults, and many of them, but in the round we see Old Uncle NHS as friend rather than foe. The principles behind his ways are noble, but not showy, and that appeals to our stoic nature. He is our largest employer, and even those of us who have not enjoyed the delights of his employment ways find ourselves from time to time as patients in his largely benevolent clutch. Most of us, for most of the time, don’t really want Old Uncle NHS blown to smithereens.
The Tories know this only too well. With the cunning of a wolf in a grandma’s clothing, they declared before the election that the NHS would be safe in their hands. And once the election was past, and their plans to nuke the NHS advanced, they knew the revolutionary extent of their radical plans must be disguised, hidden from direct view. And in this they have – Dr No concedes – been most audacious. The Big Bang has been cunningly wrapped and rebadged – as GP commissioning.
Now, this is clever. Many in the media, and indeed most non-medical people Dr No has spoken to, see GP commissioning as a ‘good thing’. What could be more sensible than devolving funding and commissioning to those closest to the patient? Who knows better what the patient’s needs than the that patient and their own doctor? A warm and comforting picture springs to mind; wise GP and worried patient together studying the Argos catalogue of NHS choice; options weighed, and a considered decision made.
Were it so, that might (or might not – not all, if any, GPs will be natural commissioners) be a ‘good thing’ – but it wont be – because GP commissioning isn’t what it seems. It isn’t your GP commissioning your care for you.
The con, the lie that puts the con back into Conservative, is in the acronym. When we read or hear GP commissioning, we imagine our general practitioner commissioning our healthcare. And what could be more welcome than that?
The trouble is, GP commissioning isn’t general practitioner commissioning, it is general practice commissioning. Only a few letters swapped, but in that short change we lose the human face of general practice: we lose our GP.
A better name for the government’s plans would be primary care commissioning – that is, commissioning at the primary care level. By that name, it might appear not dissimilar to the primary care trust based commissioning system we have now. Except for one crucial difference. PCTs were part of the NHS, their staff NHS employees doing NHS work. GP commissioning consortia are very different animals, open to all comers – and as we have already seen, all comers – including multinational corporates – can and do pitch up.
Private sector staff working with the NHS, but not for the NHS. Far cry from the cosy picture of your GP commissioning your care. As the great Dr Crippen might have said, were he still blogging, not quite Tannochbrae.