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A faulty production line

The end game was always to dismantle general practice

Dr Kailash Chand

Dr Kailash Chand

Pulse editor Jaimie Kaffash’s brilliant opinion piece last week nailed the problem at the heart of the ongoing crisis unfolding in general practice, in pointing out that there is no political will to stop practice closures.

I would argue that there is overwhelming evidence of a conspiracy to see off general practice for good, enacted by politicians from both major political parties over the past two decades. The agenda of privatisation started under the premiership of Margaret Thatcher continues unabated now with Theresa May.

And to privatise the health system, it is essential to dismantle the ‘jewel in the crown of the NHS’ – the current model of general practice. The groundwork to fragment general practice began with negotiation of the new GMS contract in 2004 by ‘New Labour’, under Tony Blair. The contract started a trend towards larger practices and federated models of working.

Private organisations entered the NHS to deliver general practice care under the new APMS contract, including multinational corporations such as United Healthcare and Virgin, as well as companies run by groups of GPs. These companies also started providing NHS walk-in centres, mobile screening units, occupational therapy and health visitors.

The GP profession is already confused and exhausted by the constant reforms

The primary responsibility for such private enterprises is to generate profit for their shareholders rather than care for patients. The commissioning system makes it easy for them to cherry-pick the services they bid to offer, so they can maximise their income from the NHS while minimising their costs.

I warned then of the dangers of this fragmentation and private delivery of services – and the need for GPs to unite to defend general practice

Now it feels like history is repeating itself. The very fabric, ethos and future of the general practice are in jeopardy from the relentless political assault.

The ‘sustainable transformation plans’ and ‘accountable care organisations’ are aiming to reduce our 8,000 GP surgeries down to 1,500 super-hubs. These changes imposed across NHS primary care by Jeremy Hunt and his colleagues are causing the meltdown of general practice, and will lead to its eventual destruction. It is an ideological, dogmatic, non-evidence based approach that demonstrates the Government does not value the quality of general practice. It appears to be determined to move from traditional GP partnerships to one where the private sector will play a much greater part in the structure and running of primary care services.

There is no evidence to support this concept, and the GP profession is already confused and exhausted by the constant reforms. GPs are leaving, and new entrants are declining to enter general practice.

When I was a GP, our practice provided a 24-hour service, 365 days a year (yes, including bank holidays). I was legally and morally responsible for the health of all our patients all the time and although it was sometimes tiring and occasionally frustrating, it was a responsibility that I and most of my GP colleagues took very seriously. GPs took pride in what they did, and were conscious they were the backbone of the health service.

For 70 years, GPs have cared for patients and their family from birth to death. They look after all their records and manage their entire healthcare. UK general practice is one of the best primary care systems in the world, admired and emulated by other countries. Proposals to turn our highly valued GP practices into healthcare hypermarkets mean a poorer quality of service, particularly for those in most need. The poor, the elderly and those with multiple illnesses – the very ones who are most in need of one doctor to co-ordinate their care – will lose the most.

It is no exaggeration to say that general practice in Britain has been dealt a death blow by an ill-thought political ideology. The proposed wholesale changes to primary care will destroy the personal continuity of care and replace it with a less effective and more expensive mishmash of ever-changing services and faces. The concept of ‘the family doctor’, so dear to the British public, will be lost forever.

The Prime Minister says she loves the NHS, but there’s a stark gap between her rhetoric and policy. She has promised a long-term funding deal to supposedly rejuvenate the NHS as it turns 70, but her policies – promoting the private sector and decimating general practice and social care – will signal an ending, not a new beginning.

Dr Kailash Chand is a retired GP from Tameside


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Readers' comments (13)

  • Were all doomed!

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  • Working At Scale + virtual consultations + AI = problem solved.
    At least, so goes the propaganda. Nigel Watson’s independent review into the partnership model will be interesting. I predict a veneer of diplomatic equivocation but basically the conclusion will adhere to the formula above.
    As to whether we can afford the brilliant model of GP that Kailash refers to, I have no proof beyond doubt. But I do have a sneaking suspicion that - if we were ever able to resuscitate it - it would provide more cost effective care than any other system; which won’t stop us from trying all the other alternatives of course.
    Sad but true. P McT is correct; we have taken a career path that is difficult to branch off from - not impossible but quite challenging, with a mortgage and a family to support.
    I predict a slow lingering demise...

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  • Some interesting points, but some vacuities too. GP partnerships, in exactly the same way as you say Private Companies exist to serve their shareholders, used to exist to maximise the profits of the partnerships. No?
    Next time you are with a group of GPs, Dr Chand, do a hands-up for how many want to go back to being responsible for their patients 24/7/365.

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  • The "responsibility" for 365 day 24/7 care beloved of Dr Chand, and the unrealistic expectations this unsustainable policy created in patients was what has brought General Practice to its knees, not the ad hoc interventions of a few APMS contracts. Five out of six Practices in my city have amalgamated recently, not because Mrs May told them to, but because they see clear advantages in working at scale.Perhaps Khailash's scratched and broken record should be consigned to the junk shop.

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  • The private provision to be embraced should be where the patient contributes something to the cost of their primary care, with balance of continuity, convenience and cost determined in a heterogeneous market of providers, yet allowing full access to the specialist nhs referrals and treatments available.

    The alternative is beauty pageant commissioning to large corporate providers where politicians are the real customer, not patients, and the service rendered reflects this.

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  • Think the piece should be forwarded to Mrs May

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  • Mr Chand held the same views I believe when he was head of the GPC - something like the Founder of my local Federation who as Chair of LMC pushed the agenda of 7 day opening and buried colleagues deeper where the sun don't shine. No use crying wolf if you were the one to feed it.

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  • It's the profession that is killing GP land. Part-time working, giving up out of hours so we no longer had the monopoly of primary care. Then we gave up being responsible for the computer systems and GPs in Scotland are now giving up being responsible for their premises. Most GPs now seem to prefer a part-time salaried service. GPs are specialising increasing the number of appointments needed, continuity of care is falling. I do not think the Government can go against the tide of what the profession seems to want. there is no plot to break General Practice, if there was the simplest thing is let the profession, now increasingly a trade, get on with its own demise.

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  • Ffs cheer up, England gonna win the World Cup! Glory awaits

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  • 24/7 cover meant 80 hour weekends and more hours when covering holidays. It was extremely difficult.
    Ultimately, it is the duty of the elected party to provide health cover.
    It is the duty of the BMA to protect its members.
    The BMA does not see this as its fundamental role, but more the preservation of the NHS. The BMA needs to define safe working, first and foremost, to avoid cases like Dr Bawa Garba.

    The days of the 80 hour weekends in GP land has gone, but it still exists for BMA members in A+E departments in North Ireland.
    Pilots define safe working for precisely that -safety reasons.
    Dr Chand, please fulfill your primary role = looking after your member welfare. If you do not, you get what you have now, as you said, doctors leaving the profession.

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