The plight of general practice is in the papers every day. Stories abound of overpaid lazy GPs being responsible for the A&E crisis, rationing care and laughing all the way to the bank while stopping off at the golf course for a swift G&T. As a result of the Health and Social Care Act the wheels are coming off the NHS and the government is fingering GPs as the culprits.
But things were different when Lansley first produced his Health and Social Care Bill like a rabbit out of a hat. GP leaders at the BMA and organisations like the NAPC saw plenty of opportunities for primary care in what was on offer. GP commissioning was seized on as the Holy Grail, what the profession had always wanted, offering the chance for GPs to take the lead in organising care for their patients.
Meldrum advised and persisted with a policy of ‘critical engagement’ with the aim of cherry-picking the bits that looked attractive while persuading the government to dump the ‘more damaging aspects’ of the bill. This naive approach failed to recognise that the bill was all of a piece, a bear trap with GP commissioning as the bait.
Plenty of warnings
From the beginning, there were many stark warnings about the reforms. Unison called the bill ‘a disaster of Titanic proportions’. Its campaign cited an early poll by doctors.net showing that two thirds of doctors did not welcome the proposals, including compulsory participation in consortia.
Other organisations were equally concerned. London Health Emergency and Keep our NHS Public predicted fragmentation and accelerated privatisation of the NHS, and warned that CCGs would be forced to act as rationing boards. Policy analysts said that GPs were being set up to take the responsibility and thus the blame for the inevitable problems that would arise from the challenges looming on the horizon.
Not only was the NHS facing a re-disorganisation big enough to be seen ‘from outer space’, but also unprecedented financial cuts (the infamous £20 billion Nicholson challenge) which were being imposed at the same time. They predicted that this perfect storm of cuts and ‘reforms’ would destabilise the NHS for years and that GPs would be the fall guys.
But GP leaders appeared deaf to these concerns. Polls conducted by other organisations such as the RCGP showed rising levels of opposition to the bill but the BMA never consulted its 150,000 members on whether they agreed with the legislation, or whether they thought the BMA should oppose it.
It’s true the BMA surveyed 20,000 members in February 2011, just after the bill was published in January and its implications analysed by medical leaders. Questions were mainly about what people were doing to implement the changes.
But there was never any attempt to ask members whether they wanted the BMA to oppose it or withdraw from commissioning. Other organisations such as the RCGP continued to survey as the process unfolded and the Government’s intentions became clearer.
Instead, the GPC began issuing guidance documents and practical instructions about how to get involved in the new structures. Many GPs were deeply troubled by what was proposed, but in the absence of any other message from their leaders had no choice but to go along with the reorganisation despite the fact that no legislation had yet been passed. This allowed ministers to claim up until the last day that doctors supported the proposals.
The rest is unfortunately history. The BMA persisted with ‘critical engagement’ long after it was clear that the government had no intention of making any concessions, and GP leaders argued against opposing the bill until the bitter end. GPs were given no chance to voice opposition or boycott commissioning, and hospital doctors were given no choices at all.
Accepting the blame
So now GPs have less control, more complexity and all of the blame. Those who fell for the bait and led us into the mess the profession now finds itself in are still in place, indeed many are currently seeking to remain leaders of the profession. They have shown no public recognition of let alone contrition for their catastrophic failure of judgement and are now vocal among those blaming the ‘reforms’ for the current crisis with no apparent acknowledgement of their role in events.
But we must also accept some responsibility. We get the politicians we deserve, in medicine as elsewhere. Through benign neglect, being happy for others to take on onerous positions on our behalf, we ended up with leaders who proved incapable of recognising and rising to the challenge, of protecting the profession and our patients from the political assault on the NHS that constituted the Health and Social Care Bill. That is one lesson we can take away as we down our G&T at the 19th hole.
Dr Jacky Davis is a BMA Council member and consultant in north London. She and Professor Raymond Tallis have co-edited NHS SOS: How the NHS Was Betrayed and How We Can Save It, published by Oneworld, out on 5 July.