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CAMHS won't see you now

NHS Direct bids to take on chronic disease care

Liberal Democrat health spokesman Paul Burstow explains his party's consensual approach to Nerys Hairon and London GP Dr Sally Whittet

Listening, consulting, negotiating. There have been more powerful rallying cries perhaps, but these are the watchwords the Liberal Democrats hope will bring them GP votes.

Earnest and eager to please, the party's health spokesman, Paul Burstow MP, is a million miles from the strident self-confidence of a Reid or a

Hutton. He spends more than an hour with Pulse, obligingly returning after an interruption for urgent business.

The LibDems, he says, will scrap political targets, listen

to GPs on IT and allow informed dissent for childhood vaccines.

'We would have a cull of all the political targets. We think targets are where clinical freedom is most fettered,' he says.

He is particularly critical of the widely-disliked 48-hour access target. 'Anecdotally the response has been to remove the ability to book in advance. It's less flexible [for patients].'

Mr Burstow also has tick-box medicine in his sights, pledging to revise the quality framework. 'It would mean we would have to amend that,' he says. 'What we have is measuring throughput rather than outcomes.'

But he is sensitive to the suggestion that GPs might be wary ­ and indeed weary ­ of further wholesale change. Again he insists he wants to listen and learn before implementing reforms.

'Sometimes you have to be unpopular if you think what you are doing is right. But you don't throw the baby out with the bathwater.

'When it comes to the QOF we would not automatically get rid of it on day one. A lot of things in train we would allow to carry on. It's an open-door policy of wanting to listen and learn.'

Mr Burstow will not pledge to scrap Choose and Book but he does think GPs have been 'treated a bit like mushrooms with the IT programme', presumably meaning they have been kept in the dark.

He says the LibDems would work to improve the policy ­ after a consultation exercise naturally.

Mr Burstow also declines to bite on the issue of enhanced services. He refuses to use the term 'postcode lottery' as he believes services should be tailored to local needs.

'We want services to face up to local problems. There will be divergences to try to meet those local needs.'

He agrees there should be no new work without pay but worries about the cost. 'Any government will wind up having a debate about if the money is sufficient,' he says.

Mr Burstow is sometimes bigger on intention than detail, insisting he must consult with GPs before committing. But he sympathises over pensions and Choose and Book.

Changes to pensions would be 'deeply demoralising and grossly unfair' to GPs approaching the end of their careers, he argues.

He says if the Government tore up pensions agreements it would be an 'unacceptable betrayal'.

He promises that under a LibDem government, any such changes would be open to negotiation and could be phased in over 20 years.

Quite what such changes might be is less clear though.

And why, Pulse asked, should GPs trust the LibDems to deliver?

The answer is that the LibDems would trust GPs: 'There will be far less meddling. Our approach to the NHS will be to run it from the bottom up rather than the top down.'

The power of consultation.

Mr Burstow's opening statement is still reverberating around my head.

When we asked about safeguarding the core values of general practice, he said GPs were central to the NHS and the LibDems wanted to shift the centre of gravity from secondary to primary care.

When I quizzed him for more detail, Mr Burstow gave an example of an initiative in his own constituency, where GPs are involved in setting up a community hospital as a kind of intermediate care provider.

But while this helps the elderly and people with chronic diseases, to me it does not seem very innovative or improve GPs' working lives.

When I asked him whether 10-minute consultations could cope with the demands we face, he seemed bemused. He didn't seem to totally understand why we are feeling so pressurised.

But I would say Mr Burstow seemed realistic ­ he did not try to promise all sorts of things that are impossible.

He seemed well briefed and to know his stuff ­ but more from a managerial viewpoint rather than a GP's.

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