Practice boundaries: Can we stop the policy now?
In the last article in the series, Dr George Farrelly asks if GPs can do anything to stop the Government abolishing practice boundaries.
I have written this series of articles in order to highlight the difficulties surrounding the Government and Department of Health’s proposal to abolish GP practice geographical boundaries, and as a means to actively resist the policy.
On the surface, it may sound appealing, but if you dig a little deeper, you discover a myriad of problems.
The politicians involved in driving the policy (Andy Burnham, then Andrew Lansley) and the Department of Health have undertaken a concerted campaign to ‘sell’ this policy to the English public; they have used the results to bolster the credibility and apparent solidity of the policy. They have studiously avoided mention of the risks, of the practical problems inherent with the proposal.
I would say that behind this policy there is a hidden aim: the abolition of GP geographical areas is in fact about the deregulation of English general practice, so that large for-profit organisations can cherry pick the profitable parts of the substantial expenditure on primary care.
In order to achieve this aim, politicians have sold this as a reform to give patients ‘choice’, they have framed general practice boundaries as a ‘constraint’ on choice rather than as a necessary feature of a community-based service, whose functioning and ecology depends on it being local, geographically defined.
To put it into plain English, I feel this policy is a scam, not by accident but by intention.
So where are we now? The policy has not yet been implemented. Andy Burnham wanted to implement the policy by September 2010; this was delayed by a change of Government, the White Paper (which included this policy), the long journey of the deeply flawed Health and Social Care Bill. In June 2011, the LMC conference voted unanimously to ‘staunchly resist’ the policy, and GPC Chair Laurence Buckman called it a ‘barking policy’.1 In October 2011, Andrew Lansley apparently performed a ‘U-turn’ on the issue when he spoke to the RCGP Annual Conference, but then subsequent statements and behaviour suggest strongly that he was merely mollifying the GPs, misrepresenting his true intentions.2 The GPC negotiated a further delay in the policy, with agreement to set outer practice boundaries and to undertake a pilot.
Will the Department of Health and Government waver from their aim? I do not think so. Their intention is to plough on with the policy, dressed up as a ‘reform’ giving people choice. Were they really interested in delivering good quality general practice to the English population, they would have gone about it in an entirely different way.
There is a real risk that we will sleep walk into a change of the structure of primary care provision which will cause real damage to general practice in England.
What you can do
I think we can stop this policy - but not, I would argue, by making representations to the Department of Health or to health ministers.
I would propose three main strategies: one is to pressurise the Parliamentary Health Select Committee to investigate this policy before it is made law. So I would invite GPs to sign a petition calling on the Health Select Committee to carry out an inquiry.3
Second, I propose that GPs take a public stand. If you think this policy will be damaging (think it through for your own context), then you need to resist it. How? By putting up a sign in your surgery saying that you oppose it. The wording could be something like this:
‘The Government and the Department of Health want to abolish GP practice boundaries. We believe they have ignored the risks this policy carries. We believe the policy will be damaging to general practice in England. For further information, [designated website listing the problems; and/or a handout at reception]. If you agree with our stand, please help by writing to your MP.’
Let your local press know about your opposition, send them a photo of your sign.
In addition, GPs (singly or as a group which would be more powerful) could make an appointment to see their MP to outline the concerns and problems.
Third, educate the press. They have been remarkably compliant so far, but I think this is mainly due to ignorance. We need to pester them to do a bit of homework, to understand how general practice works, to understand the emptiness at the centre of the DH and Government promises.
We are actually in a very strong position. The last thing the DH and Government want is light shone on this policy, because it will expose them. In poker terms, we have a royal flush, the Government and DH have rubbish, nine high.
1 Pulse. LMC leaders declare war over practice boundaries. 9 June 2011. http://www.pulsetoday.co.uk/lmc-leaders-declare-war-over-practice-boundaries/12204326.article#.UM2wOOQyI7w
2 Pulse. Lansley backs away from complete abolition of practice boundaries. http://www.pulsetoday.co.uk/lansley-backs-away-from-complete-abolition-of-practice-boundaries/12938947.article#.UM8aIKzDv5M
3 Petition for an inquiry. http://www.gopetition.com/petitions/health-select-committe-to-investigate-policy-to-abolish.html