Should the health reforms be repealed?
Conservative Health’s Dr Paul Charlson and Labour councillor Dr Zahid Chauhan debate the key issues for GPs in the 2015 elections
Dr Paul Charlson (PC) is a GP in Yorkshire and vice-chair of Conservative Health.
Dr Zahid Chuahan (ZC) is a GP in Failsworth, Manchester, and a Labour councillor in Oldham. You can follow him on Twitter @ChauhanZahid.
Should the health reforms be repealed?
PC Absolutely not. Everyone moans about constant change in the NHS and another significant change would be bad news. Clearly the NHS has to develop, and the reforms have given space for this, but now we need to make small, structural alterations, allowing sustainability and retention of good managers.
After the reforms, many people were saying we did not need the upheaval. To repeal the Health and Social Care Act and restructure again would be a disaster, particularly as the positive effects of the reforms are just starting to show.
ZC I would agree with stepwise alterations, but what has happened here is completely different and has destabilised the NHS at every level. These structural reforms were supposed to be saving money, but the Government has yet to give us an accurate figure on how much has been saved. The fact is that the NHS reforms have wasted huge sums of public money with no demonstrable benefit – money that could have been used for improving services at the point of delivery. The act should be repealed at the earliest opportunity.
Have the NHS reforms improved outcomes for patients?
ZC I don’t think so. Waiting lists for treatments are getting worse, and the same is true for access. More importantly, the Government is not trying to address the real issues of recruitment, raising quality and reducing inequalities in healthcare provision.
PC I think it’s too early to tell. There is no doubt that CCGs are working better with other services and that integration and co-working can only benefit patients in the long term, but performance varies across the NHS and so I hope the closer scrutiny that is part of the reforms will improve outcomes for poorly performing services.
Can politicians alleviate the immediate problems of the GP workforce crisis? If so how?
ZC Instead of demoralising the workforce, the Government should address recruitment issues and incentivise younger clinicians to prevent brain-drain abroad.
PC I do not believe there is an easy short-term solution. However, GP training schemes have expanded faster than medical graduates choosing general practice as a career, so the contraction of specialist training could begin to increase the numbers of graduates choosing general practice as a career.
Do you agree with shadow health secretary Andy Burnham that GPs should be open to reviewing their independent contractor status?
PC Independent contractor status has been a good model for the NHS and it needs to continue in one form or another. GPs who no longer want to be independent and work as part of a larger organisation should be allowed to opt to change their practice status to a sustainable APMS contract, which would allow other organisations the opportunity to support them in, for example, back-office functions and premises solutions, allowing GPs to get on with clinical medicine as salaried or partner stakeholders.
ZC In the current circumstances, this move would perhaps be welcomed by new GPs who do not wish to be involved in management and bureaucracy. However, we need to study the proposal in detail to understand the reasoning behind it and how it will help to improve patient care.
PC I think a range of options are worth exploring to suit the changing needs of future GPs. Paradoxically, I can see a time when consultants might look increasingly to work in a chambers model as independent NHS contractors.
Should local authorities be given more power to commission services?
PC I think the key is joint working, developing plans that address a variety of sectors’ responsibilities and trying to use the funds available as wisely as possible. Building relationships with other organisations is a major part of sharing resources such as budgets.
ZC But what is lacking in the current reforms is population-based thinking. Local authorities are in a unique position, because they have a wider knowledge of their population’s health and social care needs, so this could be one option for a future commissioning model.
What do you think of Labour’s idea for a 48-hour GP appointment target?
PC The 48-hour access target is arbitrary and unrealistic. It’s clearly just a cynical attempt to get votes.
ZC No, it’s a tried and tested policy. It certainly works well in combination with walk-in centres.
PC But it’s inappropriate to create an expectation that will not be achievable with the current workforce.
ZC All Labour is proposing is appropriate and timely access for patients to the health service. I do not see why anyone should object to this. I think we could improve access if we embed modern technology such as FaceTime, Skype, telephone consultations and email consultations – although they will all require investment and support.
Is there any sense in the GP ‘naming and shaming’ policy for cancer diagnosis floated by health secretary Jeremy Hunt?
PC This isn’t ‘naming and shaming’ – performance issues need to be tackled. It is demoralising for good performers to see poor performers allowed to continue delivering a poor service. It is always better to work with poor performers in the hope that they will become good performers by learning from others.
ZC I agree. Instead of a ‘name and shame’ culture, we should promote a ‘no blame’ culture where people learn from mistakes, which subsequently helps to improve patient care.
How can patient access to GPs be improved?
ZC ‘Working smarter’ will not be enough: we need more resources in primary care. But no single measure can improve patient access; we need more GPs, better working conditions and more integrated services in the community.
PC I agree that working smarter is not going to be enough. We need to work with patients to ensure they use the broad range of services available effectively, and further GP recruitment needs to be addressed if access to primary care is to be improved.
What do you see as the most important health issues in the run-up to the 2015 elections?
ZC The greatest risks to the future of the NHS are the reforms, and backdoor privatisation. The spiralling costs from the introduction of the private sector can only hurt the NHS.
PC I do not think the public is worried about who provides the care as long as it is good, accessible and free at the point of use. The big issue is access, and taking steps to meet rising demand, but solutions to these problems will take time and resources.