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Money men losing sight of the value of GPs

The Government must feel it has won the battle for its NHS reforms, because the language it is using to describe them is getting bolder.

Health minister Earl Howe, a former banker and no sentimentalist when it comes to preserving the public-service ethos of the NHS, has been diplomatically quiet over the past few months. Last week, though, as the health bill was voted through by MPs in the Commons, he declared that it presented private companies with ‘genuine opportunities' and encouraged them to ‘enter the fray'. He also claimed it should not matter ‘one jot' whether the NHS was run by public or private providers.

A similar point has actually been made by another minister recently, if in less provocative terms. Simon Burns wrote in Pulse that private provision in the NHS was nothing new, because GPs were themselves private providers.

But that is not an argument most GPs would accept. And for a sense of just why, here is a quote from Andrew Gardner, chief executive of private company Harmoni: ‘We have a very expensive resource in GPs. If we can precisely diagnose conditions, we can use a lower and cheaper level of skill. We think there is a big opportunity for radical change.

‘For an organisation that has a focus on growth and looking at our cost base and improving the quality of service, it is definitely something we are going to evaluate and implement in the coming months and years.'

For a company like Harmoni, with a responsibility to its shareholders as well as to its patients, such financial prudence and ambition for the bottom line is not only understandable but necessary.

But still, does it sound the kind of language you hear from your average GP? The key word is growth. It is something all private companies have to provide for their investors, and then keep on providing.

It is never enough to do what GPs tend to do, which is to focus on continuing to provide an excellent quality of service for their patients.

Not that GPs can afford to be complacent about their own practices. GPs have a key part to play in helping the NHS meet Sir David Nicholson's eye-watering £20bn efficiency challenge, and many are already being innovative in their use of nurses for roles in which doctors were once the norm.

But it is essential that innovation like this keeps a focus on QIPP's forgotten word – quality – and reshapes services in a way that makes them better, not just cheaper.

Nurses are increasingly being used to run chronic disease clinics where a diagnosis is long-established, and generally do so well. But companies like Harmoni and Care UK are also enrolling nurses in triage roles, involving a degree of diagnosis of supposedly simple conditions like strep throat, or minor injuries at an urgent care centre.

But it is easy to retrospectively declare a condition as ‘simple'. The real diagnostic trick is in distinguishing the simple from the complex in the first place. And that's a skill that, unfortunately for the money men, requires one of those expensive GPs.

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