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At the heart of general practice since 1960

Letter of the week: Real NHS reform would ask patients to contribute

Professor Steve Field is the best choice for the coalition Government's listening exercise as he will do exactly what it asks.

It does not matter what the outcome of this listening exercise is – the Conservatives can say they listened to both the BMA and RCGP, take credit and then carry on with the NHS reforms.

The genius behind the Tory party and its NHS reforms is Oliver Letwin MP, author of Privatising the world: a study into international privatisation in theory and practice. He is pro-privatisation. The NHS reforms are offering lucrative posts of £190,000 to £200,000 a year as heads of consortia to a handful of GPs (mostly already seated in PEC roles) whereas for those who work for consortia pro rata it is £40,000 for 1.5 days.

The Government hopes to win GPs over with the enticement of ‘bonuses' to consortia which perform well, much like in the City.

Of course, consortia cannot meet the increasing patient demand which the Tories know will cost £3bn a year, when on the other hand they are asked to find £20bn in efficiency savings over the next five years, so this will lead to consortia handing over services to the private sector.

The only solution is a joint one with the public, through top-up payments and

co-payments. This, Mr Letwin has said, we may revisit in four years' time – so it is for the next prospective government to dare to ask the voting public to pay towards quality healthcare and finally admit a free NHS is unsustainable in an ever-demanding society.

The one way we GPs could have stopped this poisoned chalice and the end of the traditional GP would have been with a ‘work to rule' motion from the BMA, the only medical organisation the Government is afraid of. Alas, this did not happen – unlike in 1966, when a nation of GPs stood up to the Government.

Instead we now face the end of general practice and the re-emergence of Darzi-type centres owned by GP managing directors or private companies. Some wise GPs are expanding and own 10 or more local practices as GP managing directors. I have warned health minister Earl Howe this will lead to a rise in salaried doctors and eventually fewer medical school applicants. Who would want to train for 11-13 years to be a £55,000-a-year salaried GP? By the creation of a salaried GP post, we have devalued the years of expertise a GP acquires, which merit a six-figure salary. Instead we have shown the Government GPs will accept work for less than a plumber's wage.

From Dr Una Coales, Stockwell, south London

Council member, Conservative Health

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