Can GPs compete with big business?
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7551.1172 (Published 18 May 2006) Cite this as: BMJ 2006;332:1172All rapid responses
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Doctors do not have a hope of being able to compete with big
business.
As an NHS patient, it has being an interesting process watching the
unfolding drama of the NHS being partially privatised.
What must not be forgotten is that there may be lots of areas in the
UK that are in need of good quality healthcare.
But what must also be taken into account is the patients.
We (Generation X, the ecstacy/body shock generation - Maggie
Thatchers children) were brought up with privatisation. We are these
patients.
Do remember that as ill as we all may be, we have all still had to
work and earn money. We all had to do this in the private sector, as the
country was sold to the dogs - Which means we are the employees of the
private sector. That means we ARE the big business.
Yes, some of us are heroin addicts, some are depressed, some of us
have cancer - Most of us have something.
But ones things for sure, Maggie taught us all well - If we don't like
you, we'll sell you.
Competing interests:
None declared
Competing interests: No competing interests
In referring to my semi-retired GP husband as a ‘spare driver’, I
must have confused matters! Although he did drive a bus for Glasgow
Transport, as a medical student, his strength was in his potential
flexibility in a project that was likely to involve development and
change. His PSV licence has long since expired!
The Langwith case reached the High Court over whether there was an
obligation to activate section 11 of the 2001 Health and Social Care Act,
in this particular case. The Act states, among other things, that patients
should be involved in the development and consideration of proposals for
changes in the ‘way’ in which their services are provided. Among the many
interesting questions that have been addressed, there is no suggestion
that patient views should, necessarily, determine outcomes; the issue is
about the process of taking them into account.
The national debate on privatization is a separate issue, but the
publicity given to this case has been an important part of informing
people as to how the culture and the drivers are changing in the NHS.
Although, when we put in our bid, we had no idea of what was about to
happen, we subsequently allowed our bid to be used as an illustration of
process.
I believe that the NHS belongs to the electorate, and not to the
Government or to professionals. It is worrying that the views of the
electorate have not yet been sought, nationally, on the profound
implications of allowing multi-national companies entry into the NHS. It
is beyond belief that there has been no meaningful debate in Parliament.
There are clearly arguments on both sides and the electorate should be
given the opportunity to air them. There is a basic need for a ‘risk
assessment’, if nothing else. Merely re-defining GPs as ‘private’ and
saying that they must become more commercial, in order to compete, does
not address the ethical weakness that the principle had already been
conceded without a public debate. Hoping that ‘hybrids’ will emerge is not
a robust approach to a profoundly moral issue.
We are currently seeing a Government wringing its hands because it
sold off rail franchises according to free-market criteria. Now, it
expects the companies to run the rail service according to codes of public
service. The result is not a happy one. Structures are not neutral; to
allege that they are is to demonstrate ignorance of the profound effect of
structures on behaviour. We need to face up to the reality that it may be
impossible to have a private sector that can deliver public service values
as its priority - and still survive. So, perhaps it’s time to talk.
Competing interests:
GP involved in local bid to run Langwith surgery.
Lead GP for Patient Liaison in her present practice.
Recently became a member of Keep Our NHS Public
Competing interests: No competing interests
It is no surprise to see NHS General Practice being eroded by big
business. Doctors advocate for al their patients; politicians (the
“owners” of the NHS) have pressures that are often at odds with those of
patients and therefore their GPs. Big business is well placed to act as
the agent of Government untroubled by contact with real people, GPs see
patient needs having priority over Government targets.
By seeking a system that reduces doctors… “responsibility” for
patients to an employment contract (with minimum AND MAXIMUM standards set
by managers), politicians can have less hassle, perhaps at the expense of
reduced patient care but without the electoral risk of providing for free
an increasingly expensive product to an increasing number of clients
within a limited budget.
In Scotland some years ago, a group of senior prison doctors
attempted to bid for the contract to provide health services to Scottish
prisoners but were thwarted by a tender process that appeared biased
towards a single service provider with a commercial track record. During
the run up to the process, proposals to set up a clinical partnership with
an academic department of General Practice to provide much needed clinical
research into custodial medical care failed in the face of the plans to
contract out to a “single service provider” by Scottish Prison Service.
From a professional clinical perspective the episode made no sense but it
became much easier to homogenise prisoner care and to downplay prisoner
specific issues (such as transmission of Hepatitis C) whose solutions
might have been seen as controversial.
It is common practice for public bodies to have tender processes that
favour big business over small businesses. “Risk reduction” is a term used
to camouflage the bias away from professionally led services to easily
managed services. In Government terms, “risk reduction” often involves
transferring risk away from politically sensitive bureaucratic bodies to
patients (including prisoners) whose individual catastrophes are
irrelevant to those who foot the bill.
The BMA has the resources to take counsel and seek Judicial Review of
the current process of privatisation of the NHS: dotors and their patients
needed that process before prisoner care was degraded in Scotland ‚ we now
need it for law abiding patients across the UK!
Competing interests:
Former Chairman of BMA CIvil Service Committee, Former Prison Doctor
Competing interests: No competing interests
Not a winning battle
GPs cannot win the battle with big businesses as far as I can see,
due to the lack of financial support which makes the big businesses have
the upper hand in the playing field.Even with the help of organisations
like the NHS and the medical associations , this battle looks a bleak one
and unlikely to win from the point of view of the medical profession.
Competing interests:
None declared
Competing interests: No competing interests