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Is a total loss of autonomy on the way for GPs?



The Government’s white paper for reform of the NHS in England, published last month, is an obituary for general practice. I believe that the reforms will strengthen the marketisation of the NHS, rather than restricting it.

The core elements of the infamous Lansley reforms remain in place – commercial contracts and the purchaser-provider split still the basis for delivering services, and the GP surgeries can be bought, sold or abolished. Lessons haven’t been learned from the pandemic, and there are proposals to keep the public health functions and communicable disease control  outside the NHS. 

We’ll now have a ‘ICS NHS body’ that would be the ‘cornerstone’ of the new bill. We’ll receive ‘single pot budget’ which will merge the budgets for general practice with acute and other services. It will abolish CCGs and take on some NHS England commissioning functions. The ICS will have the authority to generate their own priorities, for whom it will provide a service, and what service it will provide.

It won’t be under obligation to ensure that a whole range of services is available to their catchment population. Then there’s the potential that many ICSs will subcontract many of their activities to commercial organisations. If commissioning is outsourced, it becomes clear that GPs won’t be in control of the commissioning process. 

By the time of the next election – and, I predict, Boris Johnson still as Prime Minister – the general practice model of the last 72 years will have undergone revolutionary changes. We might begin to see GPs working as part of a broader ICSs, in larger teams and different settings – and for new employers.

These changes would be unrecognisable to a GP from 1948. The core thrust of the new reforms is to deprofessionalise and downskill the practice of medicine in this country, so as to make staff more interchangeable, easier to fire, more biddable, and, above all, cheaper.

Many GPs I talk to fear a total loss of autonomy as a result of ICSs. In fact, they quite rightly see ICSs as ‘the last nail in the coffin’ of general practice. 

Dr Kailash Chand OBE is a retired GP in Tameside

READERS' COMMENTS [5]

David Mummery 4 March, 2021 7:43 pm

Yes totally agree Kailash – unfortunately General Practice is very unlikely to remain one of the great professions in the future….shame really

A non 5 March, 2021 9:28 am

Make yourself useful while you can (and you can). I think we’ll look back and muse ‘they don’t make Drs like me any more’…cause in the future they wont. GPs like you and I wont exist. There will be people doing bits of what we do now but the single person with the experience/knowledge and breadth of skill wont be there. The general surprise at the country’s performance in vaccination is instructive. Its been achieved because its primarily been done by GPs. In fact it isn’t actually surprising at all, look how we outperformed on QOF. The genuinely surprising thing is how the Government continually underestimates our value and potential. We are very useful people, the country doesn’t really get this and as a result we’re not going to exist for much longer.

David jenkins 5 March, 2021 12:37 pm

remember joni mitchell

“you never know what you’ve got till it’s gone”

WIGIG……………..when it’s gone it’s gone. you can’t put the toothpaste back in the tube !

don’t let them say they weren’t warned !

Turn out The lights 9 March, 2021 1:32 pm

And all the professional bodies including the union have a hand in the demise.

Michael Crow 10 March, 2021 11:29 am

Younger GPs do not know what it was like before. Let’s be honest, GPs have not had much autonomy for some time now and more and more has been piled onto General Practice. It is already unrecognisable and all of us are working far harder. In addition you have to be astute business people to maintain a reasonable income. I consider myself lucky to have been able to take advantage of the “golden age”. Much of what is done by GPs is actually done for free by doctors who go the extra mile and give up family time etc. Perhaps the future described is what doctors want: Well-defined work life balance and a decent wage for contracted hours to get on with practising medicine. It will cost a lot more in the end.