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.