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Independents' Day

The best gift you can give the NHS is to support its reinstatement

The best gift for the NHS on its 70th anniversary is to support the Bill that would secure its reinstatement as a publicly owned, equitable and accountable health service, Dr Ameen Kamlana writes

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I’ve practiced as a GP in East London since 2013, and lived in the area for nearly twenty years. I’ve witnessed how both social disadvantage (for example, inadequate housing, precarious employment, cuts to services) and changes to the NHS are impacting directly on the health of my patients.

The London Chest Hospital (where I, as a medical student and patient, underwent major surgery) has been sold-off for largely unaffordable private housing development. All Saints Practice (my first and longest place of work) has been closed down, despite a shortage of GP appointments in the area. Podiatry referrals to Mile End Hospital are now commonly rejected with a letter listing alternative private providers. The introduction of the GP at Hand mobile app threatens to further destabilise under-resourced community general practice.

These are just some examples of the perpetual local developments that compelled me to try to better understand the power and motivation of individuals and institutions involved in NHS decision-making and planning.

I have come to the uncomfortable realisation that the most vulnerable people in our society are being scapegoated for the strains on the NHS, whilst a combination of marketisation and privatisation, deliberate cuts and closures, and the extortionate private finance (PFI) debt - which is decimating our health service - are not being sufficiently scrutinised. 

I am personally more concerned than ever about patient safety and litigation in the current climate

Michael Mansfield QCs astonishing Independent Healthcare Commission Report into the latest wave of structural changes exposes NHS England’s actions as poorly planned, lacking adequate public consultation and transparency, a waste of public resources, and as having a disproportionate impact on our most disadvantaged communities

The Commission called for the programme to be immediately halted pending implementation of recommendations or a judicial review, but instead, NHS England are extending their vision for the future of healthcare throughout England in the form of Five Year Forward View.

General practice is becoming increasingly stressful, with unrealistic demands and expectations being placed on us without the requisite additional support. As GPs, we feel undervalued and not listened to, and experience a lack of control and agency in our role. I am personally more concerned than ever about patient safety and litigation in the current climate.

Unless those of us who value the NHS’s founding principles fully appreciate the circumstances of our predicament and take action to remedy them, general practice as we once knew it - providing universal, comprehensive, quality and timely healthcare, free at the point of delivery - will become increasingly difficult to retrieve.

But it’s still not too late to act, and there is hope…

The NHS Reinstatement Bill – co-authored by Professor Allyson Pollock, Consultant in Public Health and Peter Roderick, Barrister (both based at the Institute of Health and Society, Newcastle University) – is unique in proposing an inspiring and detailed alternative vision for our NHS; an NHS that is once more publicly owned and provided, and accountable and efficient.

The Bill aims to restore the Health Secretary’s duty to provide healthcare (which was removed by the Health and Social Care Act in 2012), end the contracting out of services to private providers, and re-establish public health bodies directly accountable to local communities (Community Health Councils representing the interests of the public were abolished in 2003). 

The fundamental public health function of reducing health inequalities, improved working conditions through collective bargaining of terms and conditions, adequate whistle-blowing protection for NHS staff, and the removal of charges on immigrants using NHS services (introduced with the Immigration Act in 2014) are some of the other pressing issues addressed in this wide-ranging Bill.

This year marks the 70th anniversary of the NHS. It provides an opportunity to celebrate its history of achievements, and also to take action to protect it - and general practice - for future generations. If Scotland and Wales can reverse marketisation and re-establish their NHS as a universal, integrated public service, then so can we.

You can lend your support to the Campaign for the NHS Reinstatement Bill with minimal time and effort, and without fear of intimidation by CCGs or negative consequences for your career. Simply ask your MP to sign the #NHSTakeback pledge, subscribe to our mailing list, and follow us on Facebook and Twitter. You can do all of this via our website.

The best gift you can give our NHS on its 70th anniversary is support for its reinstatement.

Dr Ameen Kamlana is a GP in east London. You can follow him on Twitter @ameenkam

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Readers' comments (7)

  • The largest private contracting in the NHS is to General Practices - who are independent contractors run for profit.

    There are many calling for this to end and a fully salaried GP workforce. There is certainly logic in this - but most GP partners feel that they give a large amount of extra effort to the NHS far beyond their salaried associates.

    The idea that widespread privatisation is rampant and growing in the NHS is not supported by the evidence. The profit margin in NHS work is not sufficient to attract many into the market.

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  • Citing GPs as an example of existing privatisation in the NHS is just ridiculous. GPs work strictly within NHS framework in structure, function and ethos.
    If you imagine that Virgin running GP services is the same as NHS GPs, then either you aren't a doctor at all or you simply don't understand the issues.
    Evidence for privatisation is now in every sector of the NHS. Evidence for failure of many of these private contracts through incompetence, fraud and mismanagement is damning.
    70% of all new NHS contracts (43% by value) last year were given to private sector.
    The average value of new private sector contracts awarded is increasing substantially year on year.
    And that's just outsourcing. Privatisation works in other forms too, eg Marsden relying on private funding now for one third of its income; or US Health Insurance corporation hired to design and direct STP/ACO development; private provider companies sitting on commissioning Boards as part of ACO structure; rationing of services/treatments to force more patients to seek private treatment/insurance... it's a long and multi-faceted list.
    Please check your registration MS and,if you find out that you are indeed a doctor, start doing some research.

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  • OP has failed to mention the 100% public purchasing - demand side - of the NHS.
    This ensures the customer is HMG, rather than patients, and explains the tension in a service where the government pay for their agenda, the patient has their own agenda and the clinician has a third agenda.
    I suspect the clinician and patient are often more aligned, but as the customer is HMG, that is who is ultimately in charge.

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  • Listing closures to physical buildings is not proof of ‘privatisation’.
    Are podiatrists working privately worse than those in the nhs? Does a dr get worse when not working for an unsympathetic failing nhs trust? Do more people die from cancer in non NHS European systems (no, see OECD reports).

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  • Thank you Nick.
    I've been a GP for 30 years - mostly as a partner.
    A shame that you attack credentials rather then considering the argument.
    Dentists, optoms, GPs, podiatry etc have most often been private companies subcontracted to the NHS.
    The fact the most (afraid it is not all) "work strictly within NHS framework in structure, function and ethos" indicates that private provision can work within the NHS - and doesn't refute the facts.
    I've currently acting as locum mostly for a large provider that also runs carehomes and primary care services in prisons.
    This hasn't stopped me wanting to provide high quality holistic care for my patients.
    There are many issues in the NHS (PFI I would agree is among them) - but rampant privatisation I wouldn't put at the top of the list.

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  • Analysis of the Department of Health’s published accounts shows that the share of spending by NHS commissioners on the private sector was 7.7 per cent of the budget in 2016/17. This has increased slightly from 7.3 per cent in 2014/15, although changes in data definitions mean this is not strictly a like-for-like comparison.

    if you want the evidence (from Kingsfund August 2017)

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