New minister keen to mend fences
His tea steaming away in an Everton FC mug, health minister Andy Burnham warms to his theme. The future of general practice is, he insists, bright.
He is keen to move on
from what members of the
profession have dubbed 'GP bashing' and says he sees a 'real unanimity' about the crucial role primary care will play in the future.
But his philosophy points to a reformed system of funding, where incentives will take the place of some of the previously secure core funding GPs have grown used to.
He says: 'I sense that the long-held goal that people have always talked about, about the balance of power in the health service shifting from hospitals to community level – I would
argue it's begun to tilt.
'In the past year to 18 months, it really has been happening in a way it's never happened before.
'I think that is something
to be really celebrating and
welcoming and one message that is key to get over.'
Mr Burnham is down to earth enough to admit there have been 'differences of opinion' in the GP world – but anxious that rows are not allowed to derail the Government's reforms.
He argues: 'Those sometimes quite focused issues can polarise people and take the agenda away from the overall enhancement of primary care, which is what I believe to be happening.
'Primary care is seeing – and will continue to see – real improvements in the next five to 10 years.
'It's a time of opportunity rather than threat.'
Mr Burnham, who earlier this year shadowed a GP for a day, also dismisses outright the suggestion that GPs are overpaid for the work they do.
'No. My next-door neighbour is a GP so I have to say that!' he says, but goes on
to explain how his formative years as a researcher for Tessa Jowell in the shadow health
department were characterised by discussions with the BMA about the recruitment crisis and morale problems in inner-city general practice.
Displaying real passion, he insists that at that time primary care was at a 'desperately low ebb', and that he doesn't regret the 'step change' in GPs' pay that has resulted.
'Many more people want
to be GPs than they did 10, 15 years ago – there's no spin about that.
'They are facts and I'm very proud of that.'
So back to those differences of opinion.
Mr Burnham seems to sympathise with recent comments by NHS Employers that MPIG's best-before date may be closer than originally thought.
MPIG, he says, is an area that he is taking an interest in.
He explains: 'I think at the time the contract was agreed it was important to take people into a new world – but the agreement was that it should remain under review.
'I think it's important for us to understand what the effect of it is on the way we spend resources in primary care and whether it's actually allowing resources to be directed at the areas of greatest need.'
He adds: 'I wouldn't say it's cut and dried – and there may be a difference of view about how long it was meant to last. Obviously it was introduced at a fairly late stage in the negotiations and I don't think it
was ever anyone's expectation that it would last forever.
'And I think generally the way in which health service finance is moving, so that people don't get paid just for existing, they get paid for what they do and how well they do it – that's the logic that underpins the financial system we've got in the health service now.
'In the long term, it doesn't sit very easily with that financial framework – but I understand the reasons why it was introduced in the first place.'
Mr Burnham acknowledges that if the system were to be changed, careful thought would have to be given to the repercussions for those whom it would affect most.
But he is adamant that a change would be justified: 'The emphasis is using funding wherever we can to improve
services, and MPIG in some ways was about transition to a different world and now we're in that world the case for it is weakened.'
He sees dialogue and 'incremental change' as the key, explaining: 'The balance you've
always got to look at is between allowing the best practices
to get better but also being
sure you're protecting crucial services.'
Mr Burnham is hitting his stride and waves away nervous aides who seem anxious to draw the interview to a close.
He moves on to practice-based commissioning – about which he seems genuinely excited, describing it as a 'key engine for change' and 'one of the most crucial reform tools in the armoury'.
Mr Burnham is also pleased with the principle of the quality and outcomes framework, which he sees as 'a really exciting way to finance healthcare', although he accepts that there are areas where it could be made less formulaic and bureaucratic.
Work on learning disability healthchecks is in the pipeline and Mr Burnham says ministerial colleagues are likely to have an even bigger list of things
He says he is interested in expanding on this approach to create the right incentives within the system to offer the best possible access to patients.
The GP patient survey is an example of this, he says.
'That is a key issue for us – in some ways this again brings us back to MPIG.'
Mr Burnham explains that actions in one area can create more 'headroom' in another.
'I'm keen to switch emphasis into incentives and using money in that kind of way.
'I'd like to move away from where there's limited room to create an incentive for different ways of doing things.'
Mr Burnham says that
whatever is decided, the
balance must be between
'the general request from the public for improved access –
24-hour, 48-hour and also evenings and weekends, and
obviously specific service improvements'.
'We've got to keep those two things in tandem,' he says.
He expects the GP patient survey, the results of which are expected next month, to provide a clear picture of 'where improvements need to be made'.
He feels that huge improvements have taken place in access to primary care, and says the current problem is that GPs are 'in the spotlight'.
'Sadly in those circumstances, negative issues get made very large and the broad improvements that I think are happening get slightly lost in the clamour around the more negative issues.'
Mr Burnham says the Department of Health will ensure patient choice filters down to all healthcare provision – but, although he thinks more information is needed, he rules out GP league tables.
He suggests access, patient satisfaction and clinical data will be the key things patients will want to know about and wants to work with the profession to develop better data.
'I'd rather it be done on a
basis in which everyone agrees and obviously there is some data that's collected by everyone at the moment,' he says.
'I think the issue we have is that it's not readily accessible to the public.'
But he says he 'shies away' from suggesting more compulsory data collection, preferring to make existing data and the access survey more widely available.
Along with most ministers at the moment, he is keen to stress the 'outstanding quality of British general practice'.
But he adds: 'I also think it's improving and it will be the area of huge change and improvement in the next five to 10 years.
'It comes down to an issue
of individuals really. For the people who want to see things as an opportunity there's loads of it with practice-based commissioning.
'If people see what's happening as a threat, it comes down to how people see the world. But if it was me, I would see huge
'I would consider it an exciting time to be a GP.'
• Appointed minister of state at the Department of Health in
• Health select committee member, 2001-2003
• MP for Leigh since 2001
• Parliamentary officer for the NHS Confederation in 1997
andy burnham on...
practice working conditions
'Many more people are wanting to be GPs than 10, 15 years ago – there's no spin about that'
Primary care reform
'It's a time of opportunity rather than threat'
'It's important to understand whether it's actually allowing resources to be directed at the areas of greatest need'
'One of the most crucial reform tools in the armoury'
'I think the quality
of general practice
in this country is outstanding and
I also think it's improving'