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Independents' Day

Nothing will hit NHS GPs as hard as the Five Year Forward View

Dr Paul Hobday writes

The Five Year Forward View (FYFV) hardly caused a ripple in the health pond when published last autumn. It was welcomed by most, including all the main political parties as Simon Stevens, its author, encouraged the impression that it is all about keeping the NHS wedded to its founding principles, merely wanting to make it more financially sustainable.

When Andrew Lansley sold us the Health and Social Care Bill by promising to put GPs in charge, many believed the spin.

I worry we are being duped again. As a retired GP of 30 years I know that feeling when a large document lands on the desk. To preserve our sanity it’s unlikely to be read, let alone scrutinized as is really necessary.

The FYFV is cleverly written by management consultants and needs a forensic translation. I fear it is a Trojan horse. My concern is that the new models of care proposed are inspired by the US health market. Remember that Stevens, head of NHS England, previously worked for UnitedHealth, a large US health corporation.

The new models of care will be out-of-hospital providers (like the American Health Maintenance Organisations) which would replace GP surgeries, district general hospital (DGHs), community and ambulance services, maternity and full A&E, which Stevens describes as ‘outdated models of care’.

Its success depends on a gigantic shift of clinical services out of DGHs and into these out of hospital providers. The remaining hospital care will be divided between smaller hospitals and networks of large specialized providers (explaining one reason for ‘reconfiguration’). This allows a further bed reduction of 17,000, the equivalent of 34 DGHs. We already have one of the lowest bed/population ratios in Europe at 2.8/1000. In Germany it is 8.3.

The closure of A&E departments would accelerate in line with the plans of the medical director of NHS England, Sir Bruce Keogh, to reduce the 140 major consultant-led A&E units down to 40-70.

The FYFV also requires the removal of the GP ‘block’ and the reduction of staff costs. A different workforce from that presently used in the public sector is necessary and can only be achieved by ending the national negotiations for wages for NHS staff. If this happens, then number will be drastically reduced.

De-professionalisation will lead further to reduced standards and worse staff ratios but we will have more volunteers from our ‘Big Society’.

Staff will be required to work ‘across organizational and sector boundaries’ (ie outsourced, and transferred to private companies) and have ‘flexibility to deliver new models of care, including the development of transitional roles’ (ie meaning lower qualified staff taking on doctors and nurses roles such as at NHS111). Hence the Shape of Training review for the medical profession and the Shape of Caring review for the nurses.

The introduction of multi-specialty community providers signals the end of the traditional NHS GP as they mutate into HMOs like Kaiser Permanente which commissions and provides care for a registered population. This is why Federating is being encouraged. GPs will be employed.

The second new model of care, the primary and acute care system, will probably be established by the injections of cash and from NHS land transfer to PropCo

All the NCMs are perfectly suited for franchising out to the private sector and to be attractive to multinationals: TTIP (the Transatlantic Trade and Investment Partnership) will make this irreversible.

The test-bed for the NCMs is to be the Greater Manchester (‘Devo-Manc’) proposals: the ‘trailblazer for the objectives set out in the FYFV’ according to NHS England.

Watching political change after change has become part of life for GPs. We are battle-weary and struggle to keep our heads above water with the day-job. But we’ve never experienced anything brings together all the pieces in the marketisation of the NHS, for which competition and the Health and Social Care Act set the agenda.

The working lives of GPs will be very different in a few years’ time.

Dr Paul Hobday is a retired GP from Kent and is standing for the NHA in Maidstone and the Weald.

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Readers' comments (18)

  • Council of Despair

    02 May 2015 2:53pm

    how did you do it? become private i mean - i've checked and there isn't much info on the net - you just get pointed in the direction of BUPA ???

    i want to be private but worry about competition (NHS which is free) and loss of income?

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  • GP staff is a commodity.
    Supply will go down, demand will go up. Replace it with mignons to your peril. You cannot fathom reduced demand as the consumer rises exponentially.

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  • Scary and our likely future.
    If you've got any brains diversify
    There isn't a future for highly trained highly paid Drs in primary care. That doesn't mean you can't make a decent living but you won't be able to do it following the current model. If you've got any guts...I'd recommend Locum work. As far as I can see going freelance is the only real way of remaining in control and self employed - for the time being. Long term however....I really can't see any future in a career in General Practice over the next 10-20 years. Get out or you've only got yourself to blame's all there to read in black and white ....summarised very well in this article.

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  • Unfortunately, it's only frontline health professionals who seem to realize the dangers while CCGs and NHSE press on blindly.
    The 'Agenda for change' has become a fashion and even if your bottom is exposed - it's the in thing to do.

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  • Just following the crowd down towards the rabbit hole. Innovation they call it, with hidden motives.

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  • To bring in this model it is necessary to destroy the current system of primary care - and they're doing a damn good job. Bastards . To fight it we could all stop OOH work . Unfortunately there is no cohesion in the workforce . That is why we're finished - because we can't unite . If the Tories get in then bail out .

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  • I've always felt there's more unity in the workforce than we think ,most of our interests are aligned. It just needs the BMA to ask us what we want more often but unfortunately they seem to behave like a branch of the government.

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  • Privatisation runs apace - yet it was in no manifesto. Even since the May 15 election more and more work seems to be going to private compnaies,
    The public remain oblivious and GPs via CCGs and Federations are being used to facilitate this.

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