Gerada: GPs must stop NHS degenerating into ‘budget airline’ service

20 Oct 2011

GPs must reject ‘the language of the market' to stop the NHS from creating a gulf in healthcare between the ‘deserving and the undeserving sick', the RCGP's leader has warned in a rallying speech to RCGP Conference this morning.

In a rousing speech to a packed room of 1,700 delegates at the RCGP conference, Dr Clare Gerada, RCGP chair and a GP in Kennington, said pressures on GPs to replace ‘the language of caring with the language of marketing' risked fracturing the NHS into a ‘budget airline' style system where patients are denied care they can't afford.

In her opening address Dr Gerada, said that GPS must resist marketisation pressures to become ‘financial managers of care', and view patients as ‘tariffs'. She urged GPs to make sure they had the fingers on the ‘public's pulse, not the public's purse' and attacked Government for ‘shirking its responsibilities' by attempting to hand decisions on rationing of care to GPs. Click here to read the speech in full.

Dr Gerada attacked the influence of terms like ‘care pathways', ‘demand management' and slants on ‘frequent flyer patients' for promoting marketisation over care. She said the growing use of referral management centres was damaging care by taking key decisions on care out of the hands of GPs and placing a ‘hidden stranger' in the consulting room.

In her keynote address, which drew a standing ovation from delegates, Dr Gerada said: ‘Our profession is under pressure to replace the language of caring with the language of the market.'

'We need to remind ourselves of why we entered this profession in the workplace. On good days when my son asks me about what I did, I want to be able to say I saved a life, not I saved a budget.'

‘It is turning our patients into tariffs and us into financial managers of care. We are already embracing the language of the market when we talk about things like care pathways and demand management…Referral management centres place a "hidden stranger" in the consulting room, making decisions that that should be made by a GP. Insulting terms like ‘frequent flyer' patients are used to describe people that are sick..

‘I worry we're heading towards a situation where NHS will resemble a budget airline. Seats will be limited to whoever can muscle in first'

Click here to read more from the RCGP Conference in Liverpool throughout the day, or follow events live on Twitter @pulsetoday

| Email

READERS' COMMENTS

Robin Jackson, GP,

20 Oct 2011

I am a GP of 30 year's standing.I also hold the Finance & Contracts portfolio in my CGG. Unlike Dr Gerada, I cannot afford the luxury of political grandstanding because as a "financial manager of care" assisted by an excellent PCT team, we actually have to work in the real world where real budgets have to be accounted for.
We do not view patients as tarrifs, but their care procedures do have tarrifs, and quite rightly so in order that we can track demand and plan to meet it.Without such a system, chaos would reign.This she correctly calls "demand management"; if she prefers to replace this with "finger-in-the-wind" guesswork, I would value a tutorial.
I share her dislike of the term "frequent flyer", but the concept identifies patients in need of extra resources, and transforms their frequent admissions to hospital into a more appropriate and integrated care package.
As for her analogy of budget airlines, she may reflect on how these airlines have helped break up inefficient state monopolies and made foreign travel available to the many and not just the privileged few. In the light of last week's CQC Report, she may also wish to reconsider her apparent blanket endorsement of the NHS monopoly.

Report

Average (5Votes)

Top

Anonymous, GP Partner,

20 Oct 2011

I like Dr Gerada and I am surprised by the common sense of the RCGP in appointing her. Hopefully this will help our image too. GPs have a big image problem. I have mentioned this before. The big newspapers-AKA The Daily Mail have a habit of inciting hatred of GPs and one of the main problems is that the profession and even some medical magazines are frightened of the power of these organisations. The problem is this: appeasement and/or silence does not work-remember Hitler?? The RCGP should and must tackle this head on. I read the newspapers on-line this week and the anti-GP language was appalling. The resultant patient blogs that appeared were quite frankly amazing-calling GPs scum, evil, criminal and some rather menacing. I have pressed for action to tackle these issues but (as usual) I am just talking to my hand-there is either apathy or fear or reprisal if we act. Maybe we should try to sign a peace treaty-like Neville Chamberlain did.

Report

Average (1Vote)

Top

W H, GP Partner,

20 Oct 2011

There is no doubt that we need "financial managers of care" and I am grateful that people stand up to take on this job. However I suspect Dr Gerada's point was that we must not let this role interfere with our day job as a clinician. We are being told we are best placed to make savings for the NHS - my view is we are best placed to care for our patients. It is just possible that we cannot do both and there needs to be a genuine divide between clinician and manager for the sake of probity. The government will not say this - it is up to us.

Report

Average (0Votes)

Top

Anonymous, PCT,

20 Oct 2011

Robin Jackson - I'm an NHS qualified accountant not a GP and what you say isn't quite true. We do not have tariffs so that we can track demand. They are there as part of the policy of Choice. Chaos would not reign if tariff didn't exist - tariff items only apply to part of Acute contracts not all. Before tariff we paid by block contracts and that worked very nicely.

Dr Gerada's defence of the NHS isn't based on some sort of romantic idealism. It is based on good economic sense and a good understanding of NHS finances. Choice has opened up capacity in the NHS to allow private hospitals, community providers and 'entrepreneurial' GPs to take money out of the system. PBR has created an economy where Acutes and FTs have focused on growth rather than efficiency.

The defence of the NHS is based on the fact that efficient NHS hospitals should offer the best value for money. It requires people like you Dr Jackson to become a strategic planner rather than a number cruncher.

PCT Finance Manager

Report

Average (5Votes)

Top

Anonymous, Salaried GP,

20 Oct 2011

I am sorry but was it not markets that created salaried GP's?

was it not markets that created these mammouth practices and denied partnership opportunity when times were good?

I whole heartedly agree with the statement and I wish I could get behind and its great that someone in a position of authority has said it. It is inspiring and it does agree with my own thoughts. I just wish that they implemented what they said publicly in their own businesses.

- anonymous salaried!

Report

Average (0Votes)

Top

T T, GP Partner,

20 Oct 2011

T Gp partner GPs are the patient's advocate and I thank Dr Gerada for insisting on the importance of our role.I agree that GPs are being used to explain cuts in treatments to patients because the government will not openly discuss what they have unleashed on the public.I also work for a Referral Management Service, trying to develop guidelines to improve patient's paths to treatment in secondary care and negotiate the financial paths being cut by bodies whose motivations I do not share.I hear how frustrated Gps are by interference in their role.I would really like Gps to speak up and not assume that their future is already decided.

Report

Average (0Votes)

Top

Anonymous, Sessional/Locum GP,

23 Oct 2011

"Seats for those who can muscle in first" is a policy brought in by Alan Milburn a decade ago when he said that patients (read loud-mouths) would in future dictate the direction of the NHS. The result was that the NHS was geared to the WANTS of the fit rather than the NEEDS of the sick. Choice only exists for those fit enough to make it. The really sick and vulnerable,like the elderly, are side-lined.

Report

Average (1Vote)

Top

ADD YOUR COMMENTS

Please note You must be a registered user of PulseToday and logged in to add comments. Opinions expressed below are those of the writers and do not necessarily reflect those of PulseToday. Comments are considered in the public domain and may be used in future Pulse coverage. We accept no responsibility, legal or otherwise, for the accuracy or the content of member comments.

Comment*
Post As Anonymous User

You must be logged in to add a comment.Clickhere to login.

SIGN UP FOR EMAIL NEWSLETTERS

Keep up-to-date with the latest changes to the NHS, CPD and clinical guidelines. Sign up below or find out more.

LMCs 2012

Gerada: GPs must stop NHS degenerating into ‘budget airline’ service

SIGN UP FOR EMAIL NEWSLETTERS

POLL