Translation for Americans: GP = General Practioner (general practice
doctor)
Surgery = a doctor's office or consulting room
Chemists = Pharmacists
The Patient Stalkers
Beware of privatisation schemes dressed up as customer choice.
By George Monbiot. Published in the Guardian 10th March 2008
This was surely a victory for the people. We have lost, over the past
20 years, all kinds of public services, but next month one is due to
expand. After heavy bludgeoning by the government, Britain’s
general
practitioners have agreed to open their surgeries late into the
evening and on Saturday mornings. As Gordon Brown says, the health
service is “too often centred on the needs of the providers rather
than those of patients.”(1) Now we will have a service better
matched
to the pattern of our lives.
This, at any rate, is the government’s story, and at first sight it
is
plausible. The truth, as always, is stranger and more complex. It
begins with a bare-faced lie.
The government launched its campaign a year ago, with a press release
published by the Department of Health. This claimed that a re****t by
the Cabinet Office, published the same day, “reveals that nine out
of
ten” people polled “said they want public services, such as
GP
surgeries, that are open some evenings and weekends, even if that
means they would sometimes be shut during the working week.”(2)
This
was re****ted verbatim by the press(3), but it was a complete
fabrication. I have read the re****t(4). It contains no mention of this
poll, or anything resembling it. The terms “surgeries”,
“evening”,
“weekend” and “working week” do not occur.
But on the strength of this fiction, extended opening hours became
government policy. It is a bit like the war with Iraq: the decision to
go ahead was made before the evidence materialised. Just as the
government was publi****ng its misleading press release, Ipsos Mori was
completing the huge poll - of 2.6 million people - that the same
department had commissioned. This, surely, would sup****t its
fictitious claim. Who would not welcome longer opening hours?
To the department’s intense discomfort, Ipsos Mori found that
“the
vast majority of patients (84%) say they are satisfied with the hours
their GP practice was open during the last six months”(5). Those
who
must visit GPs most often are the most relaxed about opening hours:
only among 18-34 year olds - the healthiest section of the population
- does the level of unhappiness rise above 20%(6), and then only by a
whisker.
But, like the weapons of mass destruction, if the government said the
public demand was there, it had to be. On Thursday Gordon Brown
insisted that “people want weekend opening; people want to be able
to
see their GP in the evenings.”(7) Yes, some people do, but not very
many.
The Confederation of British Industry was also unhappy with the
results. It commissioned another survey, again from Ipsos Mori. This
received responses from just 1,014 people - one 2,500th of the
department’s sample size. It asked a slightly different question:
“how
easy or difficult was it to get an appointment at a time that was
convenient to you?”. Thirty-one percent said they had found it
“fairly
or very difficult”(8).
The CBI issued a re****t claiming that “a commonly heard complaint
is
that GP practices are not open at weekends, early in the morning or in
the evening … GP services are not responding to clear signals for
change from patients”(9). But it produced no evidence: the survey
didn’t ask about opening times. There are plenty of reasons why
patients might have found it difficult to get a convenient
appointment.
But even if the government is using dodgy figures and has misjudged
popular sup****t, what’s wrong with longer opening hours? Strange to
relate, quite a lot. In some places, where there are large numbers of
commuters who travel far to work, it makes sense. But Gordon Brown
wants to impose it on surgeries everywhere.
This means, in effect, transferring resources from children, the old
and the very sick to working people, who need the services least. GPs
will have to work ****fts, which undermines one of the most im****tant
foundations of the NHS: the continuity of care. It is not clear that
longer opening times will in reality be much more convenient for
working patients: the appointment clerks, specialist nurses,
consultants, physiotherapists, dentists, X-ray departments,
biochemistry labs, blood sampling services and computer technicians
with whom GPs work are not available in the evenings and at
weekends(10), so patients might have to come back to complete the
consultation. If the government wants a genuine health supermarket,
open all hours, it will have to pay much, much more.
So why is it so keen on this reform? Because it assists a quite
different agenda. To avoid the political firestorm big business rains
on any government that stands in its way, Gordon Brown must make
constant concessions. What business wants most is the 40% of the
economy controlled by the state. He must find clever and camouflaged
means of delivering it that do not prompt us to take to the streets.
This means waging a public relations war against GPs and the other
public sector dinosaurs who impede choice and change. It means a
thousand small steps towards privatisation. The government is
expanding the number of independent sector treatment centres, even
though they turn out to be far less efficient than the NHS and leave
the taxpayer with major liabilities(11). It is opening staggeringly
expensive polyclinics, operating seven days a week, which will be run
by multinational companies(12). It will allow the primary care trust
in Birmingham to shut the city’s surgeries and replace them with
primary care units franchised to cor****ations - the promoter of this
scheme happily admits to modelling it on McDonalds(13). It is
transferring GPs’ surgeries to supermarkets (the first was opened
by
Sainsbury’s last week(14)) and giving high-street chemists
responsibility for diagnosing and treating minor ailments, even though
they are not qualified to tell the difference between an ordinary
cough and lung cancer. No minister can now discuss the NHS without
mentioning “new providers” or “alternative
providers”, which is their
code for private companies, or “choice” and
“reform”, which means
privatisation.
The CBI has produced a long list of complaints about GPs’ failure
to
“rise to the challenge” of the market(15). In truth they are
among the
most efficient workers in the NHS. One of the reasons why their pay
has jumped so quickly is that they have responded more effectively
than the government expected to the incentives in their new contract
(giving the government a further stick with which to beat them). They
are way ahead of the hospitals in their use of information technology.
But there is money in primary care, which is why they are now in the
firing line. GPs say that the government was hoping they would reject
its demand for longer opening hours, knowing that the private sector
could then step into the breach.
None of this serves either the customer or the taxpayer. The irony of
Brown’s reforms is that they are wholly centred on the needs of the
providers rather than the patients - as long as the providers are
cor****ations. So don’t wait to take to the streets. Little by
little,
the privatisation of the NHS is happening already, disguised as a
crusade for patient power.
www.monbiot.com
References:
1. Gordon Brown, 7th January 2008. Speech on the National Health
Service.
http://www.number-10.gov.uk/output/Page14171.asp
2. Department of Health, 19th March 2007. More family doctor services
for deprived areas.
http://www.gnn.gov.uk/environment/fullDetail.asp?ReleaseID=272142&NewsAreaID=2
3. Eg Sarah Hall, 19th March 2007. Fruit, veg and a trip to the GP as
stores are asked to open surgeries. The Guardian.
4. Prime Minister’s Strategy Unit, March 2007. Policy review -
Building on progress: Public services.
http://archive.cabinetoffice.gov.uk/policy_review/documents/building_on_progress.pdf
5. Department of Health, 2007. The GP Patient Survey 2006/2007:
National Re****t, p58.
http://www.dh.gov.uk/en/Publicationsandstatistics/PublishedSurvey/GPpatientsurvey2007/DH_075127
6. ibid, p60.
7. Gordon Brown, quoted by Daniel Martin, 7th March 2008. GPs
grudgingly agree to work evenings and weekends at last. Daily Mail.
8. LLM Future Services, 2007. Survey conducted for CBI, May 30th-31st
2007. Sent to me by the CBI.
9. Confederation of British Industry, 18th September 2007. Just What
the Patient Ordered: Better GP Services.
http://www.cbi.org.uk/ndbs/press.nsf/0363c1f07c6ca12a8025671c00381cc7/f60cebe0663c98d68025734600573f81/$FILE/CBI%20re****t%20′Just%20what%20the%20patient%20ordered’%20September%202007.pdf
10. Gruffydd Penrhyn Jones, GP, pers comm.
11. Allyson M Pollock and Sylvia Godden, 23rd February 2008.
Independent sector treatment centres: evidence so far. British Medical
Journal, vol 336, pp421-424. doi:10.1136/bmj.39470.505556.80
12. See British Medical Association, January 2008. Access to GP
services in England. http://www.bma.org.uk/ap.nsf/Content/Gpaccess.
13. Nick Britten, 4th February 2008. GP surgeries ‘could be run by
Tesco or Virgin’. Daily Telegraph.
14. Hugh Wilson, 4th March 2008. The Sainsbury’s GPs: checkout,
then
check-up. The Guardian.
15. See Confederation of British Industry, 18th September 2007, ibid.
http://www.monbiot.com/archives/2008/03/11/the-patient-stalkers/
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