Very few GPs are enthusiasts for commissioning in my experience, so the lack of contested elections does not surprise me.
We are currently witnessing the greatest disaster the NHS, and particularly general practice, has ever seen. It seems unstoppable in spite of total BMA opposition. BMA leaders must try harder. We are reduced now to lobbying the House of Lords!
Some GPs are getting involved with commissioning because it is so potentially threatening. They are not ‘enthusiasts'. Often, though, the wrong people will gain unbelievable power over their peers. Most of us simply have too much to do other than commissioning, because we are looking after patients and trying to keep our practices afloat.
Meetings between partners or primary care team members are rare now, and coffee breaks – when useful information could be exchanged, together with a brief respite from the daily grind – are a thing of the past. How on earth commissioning practices will liaise and agree with one another is simply beyond me.
The job of general practice is, in short, no longer satisfying, except for the element of personal patient contact.
Hostile PCT management is still very much in evidence and PCTs should all be run down very rapidly now, so that commissioners can take over if they are ever going to succeed. PCT debts will have to be written off if commissioning is ever to stand any chance.
Fundholding did not threaten practice finance,
and neither should commissioning. There is a desperate attempt now by SHAs to continue in existence as smaller clusters. This is understandable, but totally unnecessary. Get rid of them.
Practices will soon begin to go bankrupt. I was told that by one of the current NHS Employers' negotiators 10 years ago when I was LMC chair. I didn't believe him then, but I do now. I think that is the underhand intention, as part of what to me is a very obvious privatisation agenda.
The cuts (so-called efficiency savings) that are now on the table for practice funding next year are enormous (I am not free to elucidate). There is too much secrecy from the GPC in my view, because of ‘delicate' negotiations, but I am bound by confidentiality rules.
We have lost all the hard-won advantages of the QOF and enhanced services we negotiated in 2003/4, but have been landed with vast amounts of extra work. We are being totally out-negotiated. PMS is rapidly being eroded. This is all very devious.
Do you trust politicians with your NHS? I don't. The only remaining benefit of the new contract was the splitting off of out-of-hours work. Even that has been under attack with the extended-hours fiasco.
The last time we were threatened by a coalition, we had Nelson. We need him back.
From Dr Peter Fellows,
Lydney, Gloucestershire President-elect, BMA Gloucestershire Division