GPs 'bang in middle' of Kerr's Scottish vision
By Rob Finch
There is a marked contrast between Andy Kerr, Scotland's minister for health, and his English counterpart Patricia Hewitt.
Unlike Hewitt's measured platitudes, Kerr talks fast. He rattles out the rationale for his NHS strategy like a man told he'll be cut off at any second.
And he talks straight. Questions are addressed directly. 'Make no bones about it' is a favourite phrase. 'My job is the improvement of the health of the nation,' he says. 'Let's tackle our biggest killers. Let's deal with CHD, stroke and cancer.'
This gives a clue to the most important difference of all. Kerr has very different priorities. In his rapid-fire style, he shoots down almost all of Hewitt's flagship policies.
On foundation hospitals: 'Look at the geography a min-ute. Where and how in Scotland?' he says. 'What's it all about in terms of plonking down a foundation hospital? What effect would it have on the rest of the health service? I just don't see that as a valid strategy for Scotland.'
Practice-based commissioning (PBC) gets similarly short shrift. He says: 'I don't see that is
necessary, I don't see that's appropriate.
'What folk want is not whether my GP can commission a service and offer five choices of hospital is it? Have I got safe and local access to health care? That's what we're about.'
His summary of all of the English reforms is dismissive: 'Whatever's happening elsewhere in the UK, good for them.'
The evidence of this different approach is apparent in Kerr's choice of directed enhanced services for Scotland.
While GPs in England will be chasing cash for delivering essentially political goals access, Choose and Book, PBC and IT the focus in Scotland is clinical.
Final details are still to be worked out, but access is the
only English DES replicated in Scotland. The others will focus on cancer referrals, the health of carers and people with learning disabilities and setting up cardiovascular risk registers.
With the latter, this, ironically, means GPs in Scotland will be paid for implementing NICE guidance on statins for England and Wales, whereas English and Welsh GPs are not.
Kerr says the limited funding available for the DESs only £12.6 million forced him to prioritise the most important issues for Scotland.
He says: 'I got a menu of choice and through conversations with GPs I know, health officials, board chairs, I coalesced around what makes sense in terms of Delivering for Health and early impact.
'There are some issues that may have fallen below the line, there may be other areas that maybe we'll return to in the
Delivering for Health is the Soviet-style 10-year plan for the NHS in Scotland produced by Kerr's department last year.
The word 'choice' appears only half a dozen times in its 81 pages. Commissioning only twice.
And although the 'independent' sector will be given a role in secondary care, there is no mention of private delivery of GP services.
At its heart is a call for a network of community health centres, with GPs working in them, to bring care closer to people's homes, particularly those in deprived areas.
Kerr explains it as focusing on the underlying causes of the yawning health inequalities north of the border. And GPs, he says, will be 'bang in the middle' of delivering it. 'We want to really get on the front foot with regard to preventive and anticipatory care,' he says.
'We look to a community service that is part of our NHS. That community health service is led by the health care team at a local level, which means our GPs, and through their practices access to other services nurse specialists, pharmacists, dietitians and physiotherapists. As local as possible but as specialised as necessary.'
So what do GPs in Scotland think of all this? There's few who would swap with their English counterparts, despite the £10,000 a year pay gap.
Dr Peter Wilkes, a GP in Drumnadrochit, Highlands, describes Kerr's vision as 'much more thoughtful than what Blair is doing in England'.
And Dr Gregor Purdie, a GP in Castle Douglas, Dumfries and Galloway, says: 'I think we're pleased we're not going to get anything like Choose and Book here. There's been no great clamour for the English way.'
Only the absence of practice-based commissioning provokes any questions.
Dr Des Spence, a GP in Glasgow, says PBC is necessary 'to get primary and secondary care working to the same objectives the more power that is given to doctors the more you get round the managers who build up their little empires'.
And Dr David Love, joint chair GPC Scotland, says if PBC works in England, GPs will want Kerr to look again at introducing it in Scotland.
This generally positive reaction from GPs is the final contrast between Kerr and the English Health Secretary. While support for Hewitt is ebbing away, he has still has GPs on side.
How Scotland and England differ
· 'Universal coverage' for practice-based commissioning
· All GP referrals booked via Choose and Book
· Complicated access criteria based on patient survey
· Target for 15 per cent private sector provision
of GP services
· Enhanced services linked to political targets
· No practice-based commissioning
· No Choose and Book
· Simple access target for patient to see a GP within 48 hours
· No private sector
· Clinical enhanced services on cardiovascular risk, cancer referral, learning disabilities and health of carers
· Plan to build new community health centres