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Why GPs must fight the bill

GP registrar Dr Stuart Sutton explains why it is crucial for the future of the profession that GPs are vocal in their opposition to the Government's health reforms

GPs are quickly becoming the fig leaf covering the naked truth that the NHS reforms are unwanted, ill judged, hugely risky and wholly unpopular with the public.

While the Government 'pauses' to listen to concerns over the bill, ministers continue to cite that GPs back the reforms. They say that the fourth wave of pathfinder practices brings the coverage of the English population to 90% (the fact that 55% of pathfinder practices do not support the bill seems, helpfully, to have been ignored).

But as opposition to the Bill mounts all eyes will turn to general practice – why are some so keen to throw their weight behind such fundamentally flawed reforms?

Splashed all over the TV news tickers is a harbinger of the criticism to come: 'Concerns GPs may be seen to put profits before patients' proclaims the BBC News channel recently – surely not good publicity for those desperate to push ahead with commissioning lock, stock and barrel.

Whilst the RCGP stance has toughened since the arrival of Dr Clare Gerada the fact that the outgoing chair, Professor Steve Field, is now engaged in a PR spin campaign on behalf of the Government makes GPs seem even further out of step with professional and public opinion.

Questions will, rightly or wrongly, be raised about why the group with the most to gain (in terms of power, influence and possibly money) are the least vocal in their opposition to the bill and its inherent conflicts of interest.

It seems unlikely that consortia will invite critical voices to join their ranks nor will established local GPs (mainly partners) be likely to make space for newly qualified GPs or local salaried doctors. Those with the most ambition are likely to be a shoo-in for the role of chair of local commissioning groups whilst some of the best, most dedicated clinicians are far too busy doing what I have spent the last three years studying for my MRCGP to do – treating patients.

Seeing local consortia leaders suggest that GPs refer to outpatient services that they run or own (as private enterprises) fills me with a mixture of emotions: anger at the fact that they are taking vital money from the local NHS hospital, thereby risking its viability, and dismay at what, on the face of it, appears to be an effort to make money and wield more power locally.

What does the future hold for those of us who are just about to begin our career as fully qualified GPs?

It used to be the fear of spending years as a locum or part time salaried GP whilst desperately seeking what used to be the cornerstone of general practice – partnership. Now we are at a critical turning point where one of two parallel visions seems possible.

In the first we are working in a 'reformed' NHS where patient choice is a thing of the past and every decision we make has to be cleared by our employer to ensure that they do not go over-budget and miss their cost reduction targets (thus incurring the wrath of other GPs in their consortia) whilst patients see us as greedy, overpaid bureaucrats who do the Government's dirty work of blocking access to care.

In another, somewhat preferable, future the bill is dead and as the cost of employing a salaried doctor appears less appealing more partnerships are available; we are able to engage with commissioning through pared down PCTs and national, evidence-based NICE assessments guide our decisions and, best of all, we are still viewed by our patients as having their best interests at heart.

Not much of a choice really is it? And for Mr Lansley (and Professor Field) – were you listening?

Dr Stuart Sutton is a GP registrar in Newham and a London Associate in Training representative.

Dr Stuart Sutton