Coffey, no sugar

Editor Jaimie Kaffash on the health secretary’s new plan

In a way, I owe Thérèse Coffey a debt of gratitude. When we heard she was publishing her plan on the Thursday we were due to go to press, it put the whole Pulse team in a quandary. Was this going to be a seismic change to general practice from the new, radical Government? Would we have to put Dr Coffey on the front cover and rejig the whole magazine? So when the plan came out and turned out to be a whole load of nothingness, it significantly reduced our workload. 

But reducing the Pulse team’s workload wasn’t the aim. The only aim in terms of general practice should have been reducing workload for GPs and their teams. Being fair, there are a couple of policies that – although lacking in detail – do have some potential: addressing the ridiculous anomaly whereby GPs are taxed on pension benefits they will never receive; and the provision allowing pharmacists to prescribe contraception. 

Realistically, these are drops in the ocean. But the plan achieved what was clearly Dr Coffey’s main aim – to generate headlines around tackling GP waiting times. The pledge to offer GP appointments within two weeks led the news agenda, firmly framing Dr Coffey as someone who understands the problems faced by patients. 

Let’s be clear – there is no enforceable target. In an LBC radio interview, Dr Coffey explained that the mechanism for ‘enforcing’ the target was publishing practice-level waiting times and allowing patients to vote with their feet, which would see funding move with them. 

This of course won’t bring waiting times down. When the data are published in November, a functioning free market won’t suddenly appear. We know from our Lost Practices investigation that surgeries in deprived areas struggle more than others. Those patients will find that all their local practices have longer waiting times. 

If, somehow, patients do act on Dr Coffey’s advice and – even less likely – a practice has managed to keep its waiting times shorter than those of its neighbours, the influx of patients flocking in as a result of these tables means they won’t be short for much longer. The impact on continuity of care of patients merrily moving around based on the latest data is not even considered.

In reality, patients won’t look at the data. Their local newspapers will, and some practices will inevitably be stigmatised. Patients won’t switch practices, but they will be keen to remind their GPs about the two-week pledge whenever they feel they have suboptimal care. 

Because what this is really doing is moving any responsibility for the state of general practice away from the party that has been running the NHS for 12 years and on to GP practices. Dr Coffey is, of course, by no means the first health secretary to do this. 

But she is implicitly telling the public that the reason appointment times are so long is because some individual GP practices are performing badly, and now they have the data to prove it. This ignores the structural factors that have left the profession in crisis: years of underfunding; a stated policy of making GPs pay ‘penance’ for the 2004 contract; funding coming with strings attached; and ministers stoking demand via the media. GPs are being handed responsibility for social problems that are the result of years of austerity.

Sadly, the tactic will work and GPs will find themselves at the sharp end of more bashing in the media, while the health secretary parades as the patients’ champion. There is certainly no sweetness in this Coffey plan. 

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk