Mocked Lord Warner warns GPs 'you are out of touch'
Lord Warner was heckled and laughed at by GPs at last month's LMC conference, writes Ian Cameron.
His comments on the 'statesmanlike' silence the Government maintained over GPs' '£250,000' salaries, on the 'high level of trust' ministers hold for GPs and on Choose and Book's 'teething problems' were greeted with derision.
Finally, after another round of guffaws when he mentioned extending opening hours, the health minister got annoyed and warned GPs not to laugh too hard.
Implicit was the suggestion that it was not he who was out of touch, rather GPs' resistance to patient-friendly proposals that jarred with what the public wants.
It's a theme he returns to two weeks later in his Richmond House office.
GPs, he says, must embrace the demands of an increasingly consumerist society.
If patients want longer
opening hours, more responsive telephone and appointment systems – as he puts it, 'much more flexibility in the way they interact with professionals' – then who are GPs to stop them?
'You can't insulate health care services, including primary care, from social changes,' he says.
'It's no good pretending you can. No minister can insulate the system from those changes. GPs and primary care services are going to adapt and change – they have always done that – but the pace of change is speeding up.'
If the public were entirely satisfied with the present range of services, he says, why would they have asked for changes?
'The public have great confidence in GPs but it doesn't follow they accept the present pattern of service provision being fit for purpose.'
With that in mind, he says it is not just the concept of 'under-doctoring' that determines whether provision is adequate. The rising number of people visiting A&E is, he argues, indicative of primary care failings.
'We are dealing with long-
established problems that used to be called ''under-doctored'' but the fact is they are under-provided for. It goes wider than doctors,' he says.
For this reason, Lord Warner is unapologetic about the number of PCTs revealed in a recent Pulse survey to be planning alternative provider medical services (APMS) contracts to 'improve' services using the private sector – even though most of the areas are not those GPs would pick out as struggling.
He says he would not discourage any PCT from following the same route: 'It's not surprising that PCTs, feeling more confident in their commissioning role, are willing to look at a wider range of services.
'What you have got is PCTs trying to tackle that, encouraged by Government and not being satisfied with the status quo.'
Despite the strong evidence to the contrary, Lord Warner adds that GPs are in prime
position to take advantage. Indeed, he says it is 'insulting' to suggest they cannot compete with multi-billion pound cor-
porates such as UnitedHealth.
'If I was sitting in the commercial sector they would argue the system favours incumbents and GPs have a head start in knowing more about their
local communities than an outsider coming in.'
Hence, GPs cannot expect to be given special treatment, he adds, before swatting away com- plaints that the paperwork involved in bidding is too onerous: 'A degree of paperwork is essential if you are going to be clear what you are contracting for.'
So how different will primary care look when the dust settles on the latest revolution? Lord Warner says it will certainly be more diverse, but he claims the private sector will remain on the periphery.
Given this week's revelation that the Department of Health is tendering for private firms to run entire PCTs, this is somewhat hard to believe.
Lord Warner's final words include a warning to GPs that to compete, and to win, against new providers they must play the game that the Government has started.
'The public want the most effective persons to provide services and don't mind who they are, providing they are operating under the badge of the NHS.'
What GPs say....
• 'In most cases GPs have fantastic satisfaction levels. They do have to accept longer opening hours, but they just have to tweak access.'
– Dr David Jenner,
NHS Alliance new
• 'The evidence suggests the current GP community is not being very successful. Most of the contracts are going to the likes of Care UK, Mercury and United.'
– Dr James Kingsland, chair
of the National Association of Primary Care