‘At last, we have a college chair with some balls.’ That effusive, if slightly ironic, comment was left by one GP on Pulse’s website in response to Dr Clare Gerada’s explosive arrival as head of the RCGP, back in late 2010. More than a year later, and Dr Gerada is still proving that whatever else she may or may not be, she is certainly brave. Last week, she chose to step outside the comforting consensus of the Academy of Medical Royal Colleges, which has been meeting to discuss its position on the health bill, and unilaterally called for the bill to be withdrawn. She took the decision without even covering her back with a council vote, having been handed a mandate from her colleagues several weeks ago when the RCGP ran its latest tracker poll of GP opinion.
Dr Gerada does stand shoulder to shoulder with the BMA in demanding the health bill be rammed into touch. But elsewhere in the world of general practice, the Government’s plans have their proponents as well as their critics.
The NHS Alliance and the National Association of Primary Care have been enthusiastic advocates for GP commissioning for many years now – even if some of their members are becoming nervous about the Government’s plans – and the Family Doctor Association, too, is broadly onside. So then, how justified is Dr Gerada in claiming that 90% of GPs oppose the health bill?
The answer probably depends on what you mean by the bill. If you were referring simply to its top-line principle, that decisions about the NHS should be taken by doctors rather than managers, you would find GP opinion rather more nuanced than Dr Gerada has implied – still with plenty of sceptics, but with others willing to give the Government’s plans a hearing. But the health bill is far more than just a lot of warm words about the potential for clinical leadership. It is a huge top-down upheaval of an NHS that is already missing its efficiency targets, an opening up of everything from community services to LESs to any qualified provider, and the creation of a fully open market in management support in as little as two years. It is that frighteningly radical package – by turns described as Maoist and neo-liberal – which has so spooked GPs.
Dr Gerada speaks for a large part of general practice when she warns that the health bill, even after its latest raft of amendments, is likely to prove damaging to the NHS. Unfortunately, blanket anger looks unlikely to be enough to force the Government to think again – it has a habit of ignoring and marginalising its critics.
If general practice is still to force concessions from the Government, we need to hear more from those GPs – like some of those who spoke out last week – who support the principle of GP commissioning, but believe the freedom of GPs to lead change and reshape services will be fatally undermined by the health bill’s obsession with the market. The Government may be deaf to those it views as its enemies, but perhaps there is still hope it will listen to its few remaining friends.