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What the white paper really means

A trainee GP sums up the Government's plans for the NHS in three words, in the latest post from Jobbing Doctor.

The Jobbing Doctor spends part of his week as an educator.

Over the years we have regularly had our titles changed. Initially we were called course organisers, then - for a short while - we were amalgamated with others into a group called GP tutors; then we reverted to course organisers, then primary care medical educators, and more recently training programme directors.

Frankly, the title has not made a blind bit of difference, and the change has been promoted by bureaucrats coping with one of many reorganisations.

It means that, for 20 years, I have been preparing the GPs of the future in my little corner of this sceptr'd isle.

We have just had a new lot starting. Around 20 fresh faces pledging their future to general practice. Until the last two years I would have had no difficulty being positive about a career in general practice. In some senses I am still very positive, but the caveats are so much more evident.

We have just emerged from a two day residential course, and there has been a good opportunity to discuss and debate issues. For whatever reason, the young doctors seem to hang on to the Jobbing Doctor's every word, and therefore I need to be rather circumspect in what I say about Government, and health authorities. I am not able to say exactly what I feel.

Why do I feel more negative about the future? I have concerns really about the direction of travel of medicine in the UK: more specifically in England. We have seen white paper after white paper, all with hubristic titles, all with major managerial changes, and - as yet - none of them making a huge difference.

We have seen health secretaries come and go (and they have been a fairly talentless bunch, I have to say). We have had quite a lot of publicity about all these changes, promising a new nirvana. Underneath all of this, the Jobbing Doctor shrugs his shoulders, and gets on with the ordinary task of dealing with patients.

My general attitude to all of this top-down change is that if we ignore it for long enough, it will simply go away. But I think that era is over now.

The blocks are in place for a significant change in the NHS. Fragmentation, contestability and plurality are the key words. The market is slipping quietly into place. The politicians, bureaucrats and their advisers have achieved their ambition. The professions are controlled, manipulated, ignored and emasculated. The key factor now is money.

In the next few years the NHS will disappear as we know it. It has already started with independent sector treatment centres, private out-of-hours providers and other areas being farmed out to generate profit.

GPs are being given the opportunity to commission services from ‘any willing provider', and that is code for the private sector.

At my conference there is a section where the delegates (the young GPs to be) can air any subject they want. We call it ‘soap box'. The main subject matter was about how we saw the white paper changes. I responded with what I thought was a diplomatic and measured response pointing out the perceived benefits and the potential risks.

I rambled on a bit (I usually do). After a three minute answer that tried to balance the pluses and minuses, I threw the subject open to all the doctors in the audience, and asked them for their comments.

In three words, one of the doctors summed it all up.

‘It's about privatisation', she said.

The thing is, she was completely right.

The Jobbing Doctor is a general practitioner in a deprived urban area of England.

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