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Independents' Day

Labour needs to 'weaponise' general practice

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The general election is mere months away and the state of the NHS has become the foremost issue of importance for voters. It is not surprising after the lurid headlines of the past few weeks.

The Conservatives already know that their record on the NHS is terrible, and have instead chosen to ignore it. This is probably a wise idea. Let’s face it; their £3bn reorganisation paralysed the health service just at the time it should have been figuring out on how to survive a winter crisis, er, just like the one we are currently experiencing.

Meanwhile, Labour has taken full advantage. Leader Ed Miliband has allegedly said that he wanted to ‘weaponise’ the NHS for the party and he has certainly done that.

‘The NHS as you know it cannot survive another five more years of David Cameron’ says one of the party’s election posters. Shadow ministers make bleak predictions about another Conservative-led government leading to waiting lists reaching 4m and more than 20m patients waiting a week or more to see a GP. Scary stuff.

But what are Labour’s solutions if they come to power? The 10-year plan published today suggests a dispiriting (but familiar) mix of blunt targets and top-down solutions. It is a plan that could have been written by Gordon Brown.

It promises same-day urgent GP appointments and the reintroduction of the 48-hour target. This may play well with focus groups, but they risk reintroducing the hideous 9am scramble for appointments and five minute slots. Yes, it comes with £100m of new funding, but that works out at £240 per practice a week (barely enough to pay a locum for one session) and it is bound to mean practices holding off from booking longer-term slots. A recipe for chaos.

Funding for 8,000 more GPs is welcome – heaven knows we need them – but they take three years to train and this will not tackle the crippling workload in general practice right now and we are going to need an awful lot more if Labour continue to make silly pledges like GPs fixing social problems, such as fuel poverty.

Getting rid of competition law is a superb idea and integrating primary and secondary care (in principle) is sensible. But will GPs really want to be salaried lackeys of huge integrated care organisations, and what happens to patients and practices stuck outside their walls?

Ed Miliband could be our next Prime Minister and his strongest card should be the NHS. The coalition has failed to come up with any realistic narrative on how the NHS should change and the whole service is crying out for a leader that stop the wild policy promises and rebuild the damage done to it over the past five years.

But so far Labour’s ideas have been less than inspiring. In fact, the one who is really showing leadership is ex-adviser to Tony Blair NHS chief executive Simon Stevens.

His Five-Year Forward View had more sense in it than one page of Labour’s 10-year NHS plan and he is already steadily making progress. Recently, all GP practices were invited to pitch their ideas about how to spend £1bn of infrastructure funding to improve their surgeries  – an impressive way to collect the best of the ideas on the ground, rather than imposing something from above (albeit with a very short deadline of the 16 February).

The plans are restricted in that they must boost access and help the vulnerable elderly, but Mr Stevens knows that GPs have the imagination and the entrepreneurial spirit to design a service that will improve care for their patients and – I am assured by insiders – he is determined to not have a fixed idea of what he wants to see. He wants to ‘weaponise’ GPs to change themselves, rather than pummel them into submission.

This is a genuine change in leadership style for the NHS. And currently it is in stark contrast to the reflex ‘command and control’ approach of the Labour party that is threatening to make a return. It has the potential to empower the profession and give it back a sense of control over its future.

If Ed Miliband genuinely wants to give the NHS ‘time to care’ he needs to also give it room to breathe and come up with its own solutions.

He should take more notice of the former Labour adviser currently installed at Skipton House, and recalibrate his approach.

Nigel Praities is editor of Pulse. This blog was updated on 28/01/15 to reflect new details from the 10-year plan.

Contact Nigel by email - or on Twitter @nigelpraities

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Readers' comments (11)

  • G P'S in my view are the people who should be able to assess a patients situation in terms of their physical and mental health and if lack of heating, malnutrition or other social conditions are playing a part. I am at a loss to understand why you oppose this. Integrating social care/medical care surely would begin with the GP in many cases.

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  • Sorry one more point.
    I see the one thing you point out you approve of from Simon Stevens is participation by GPs in £1bn for infrastructure. Whilst I am sure improving surgeries is important, with all the current problems more emphasis to address the problems patients are experiencing would be more appropriate.

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  • Can't do everything love!

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  • In answer to Christine Coombe's posting:
    1. Assessing a person's heating is not what GPs are trained to do. Millions are spent training GPs - and then getting them doing something they are not trained for is a nonsense. We should be spending our limited time doing what we are trained for. Social workers are trained to assess a person's social circumstances. Let them do it. The only reason that the Labour plan proposes GPs do what social workers should be doing is that our open-ended slave labour contract can absorb the extra work with no funding commitment, whereas, if they got social workers to do this, they would have to pay them.
    2. The second reason for getting social workers to do this work is that they have direct access to the funding implication of their findings. If GPs did this assessment, what would it mean? We have no access to the funding that could resolve the problem. It would be a completely meaningless exercise.

    But then this is what you get when you have politicians expounding about a health service that they know nothing about.

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  • Its all about proper funding for the Welfare State of which GP's are one part.
    Don't tell me we need an Austerity Policy when £billions are spent on War -when £billions are avoided in Taxes, When the 1% own 50% of the wealth.
    The rotten system must be challenged and by ALL health professionals too.
    Apathy creates the inequalities

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  • War is how we make our money in the UK/USA Wynne unfortunately.

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  • Good summary of the issues and the approach of Labour to this problem. Needs to be a bottom up solution or it will be Command and control of collapse!

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  • 8000 new GPs: great!
    Recruiting strapline?
    "Calling all Junior Doctors, we need your sharp intellect and expensively trained clinical skills, oh, and a working knowledge of loft insulation is a must....."

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  • Harry Longman

    The Tories gift Labour an open goal on the NHS. Keeper walked off the field for what the voters call the biggest issue. Better: they give them a penalty shot with all the crisis headlines in the last month. What do Labour do? Sky the ball into the stands with an evidence free rhetoric and opinion piece which amounts to, yes, a redisorganisation of the NHS.

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  • I am not a heating engineer nor a social worker. So GPs investigating patients heating situation is a bizarre idea. And let's not return to stupid top-down target-led management of GP appointments. The fact is to meet current demand for appointments (face to face or telephone) requires 100 appointments per 1000 patients per week. At best a PMS contract funds 66 appointments per 1000 pts if you allow average appt time of 10 mins. Only some APMS contracts have paid sufficiently to provide more than this. In short General Practice is grossly underfunded for what we are being asked to deliver. Neither Conservatives nor Labour have addressed this.

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