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At the heart of general practice since 1960

A (short) tale of four health secretaries

Editor Sue McNulty tries to grasp where it's all going with these reforms following a visit to number 10

Editor Sue McNulty tries to grasp where it's all going with these reforms following a visit to number 10

At a breakfast interview at last year's NAPC conference, Stephen Dorrell, revealed a sense of satisfaction that the purchaser provider split was now accepted in the NHS.

At a NHS Alliance pre-annual conference dinner last year, former health secretary Alan Milburn, gave a candid speech where he said that while the number of private companies to enter the NHS under his watch was very small, their entrance was nevertheless very significant.

In his memoirs, Tony Blair, revealed his regret at scrapping fundholding and not going further with healthcare reforms.

The year before last, I went to a King's Fund breakfast briefing where the then new health secretary, Andy Burnham, gave a speech which included a single line on the NHS being the ‘preferred provider'. It had me scratching my head when I got back to the office as I really couldn't understand what he meant. What did the NHS need protecting from? I wondered.

And in the weeks that followed, the press reported colleagues giving Mr Burnham a hard time for this comment and the damage it could do to relations with private providers.

Fast forward to last week, where I joined 100 GPs from the pathfinders at a 10 Downing Street reception.

Among them was the former Labour MP, Howard Stoate now the newly elected chair of Bexley consortium.

Prime Minister, David Cameron, reportedly quipped something to him along the lines of ‘what are you doing here?'.

And then in his speech, David Cameron, said the reforms were not a revolution but an evolution of what previous governments had put in place.

‘Many of you have said, you're already doing some of this' he added.

But that's certainly not how it's perceived ‘out there'.

BMA consultant committee chair, Dr Mark Porter, was on the radio the other day saying ‘if you're going to treat the NHS like a market..' Er, it's been set up to be a market for quite some time Dr Porter, where've you been?

And then Fiona Phillips, (a breakfast telly presenter for those out of touch with popular culture) was on telly the other night saying how she fears seeing a ‘pound sign appear' next to her GP's head when she discusses which treatment he should send her for.

So where is my political commentary heading to here?

First, the coalition government's health reforms could be their potential downfall even though it was Labour which created them.

Second, there are many of us who must feel how Howard Stoate did in number 10. We can see the sense of the reforms, we're just not quite sure where it's going to end up.

I attended a Westminster Health Forum conference yesterday on the new regulatory powers of Monitor and CQC. To say it was an eye-opener is an understatement.

Think water, rail lines and utilities and then add health to that list.

The challenge ahead is to ensure the right balance between NHS and private companies in the provider marketplace. Former economic adviser to the DH, Dr Peter Cutler, told the NAPC conference last year that his ‘nirvana' would be 50/50.

The NHS is an emotion-packed concept and many GPs are fiercely loyal to it, despite realising much could be improved.

Though an antidote to that emotion is the pre-election line from Nick Clegg ‘the remarkable thing about the NHS is that it's unremarkable'.

Back to GPs and I wonder if we will see them ‘influence' the market. Will they ‘buy NHS' in the way British consumers were encouraged to ‘Buy British' when we entered the EU market 25 odd years ago?

I've run this ‘Buy NHS' campaign past two grassroots GPs.

The first said he is fed up with the standard of care at his local hospital but would prefer to send patients to another NHS hospital 30 miles away rather than to a private provider but that transport is a barrier. Time to roll out the minibuses used under fundholding to transport patients? And even with the choice of another hospital he would still look to send his neurology patients to an alternative provider because of how poorly his patients are cared for by the NHS.

The second GP was all for putting a bit of pressure on her existing acute trust and fed up with the daily grind it creates for her with patients upset at the standard of care, lack of discharge letters etc.

GPs across the spectrum have a tipping point it seems.

sue mcnulty

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