I have written this series of articles in order to highlight the difficulties surrounding the Government and Department of Health’s proposal to abolish GP practice geographical boundaries, and as a means to actively resist the policy. On the surface, it may sound appealing, but if you scratch the surface you discover a myriad of problems. The politicians involved in driving the policy (Andy Burnham, then Andrew Lansley) and the Department of Health have undertaken a concerted campaign to ‘sell’ this policy to the English public; they have used the results from a ‘rigged’ vote to bolster the credibility and (apparent) solidity of the policy. They have studiously avoided mention of the risks, of the very real practical problems inherent with the proposal. At best we can say that they are remarkably ignorant, arrogant, and stupid. If this is the case, what are they doing in charge of the country’s health system?
Another explanation is that there is a hidden aim: the abolishing of GP geographical areas is really about the deregulation of English general practice so that large for-profit organisations can cherry-pick the profitable parts of the substantial expenditure on primary care. In order to achieve this aim, they have sold this as a reform to give patients ‘choice’, they have framed general practice boundaries as a ‘constraint’ on choice rather than as a necessary feature of a community-based service, whose functioning and ecology depends on it being local, geographically defined. So they have carried out a deception and are continuing with the deception. To put it into plain English, this policy is a scam, not by accident but by intention. Were this a financial product, it would be classed as mis-selling and probably fraudulent.
So where are we now? The policy has not yet been implemented. Andy Burnham wanted to implement the policy by September 2010; this was delayed by a change of Government, the White Paper (which included this policy), the long journey of the deeply flawed Health and Social Care Bill. In June 2011, the LMC conference voted unanimously to ‘staunchly resist’ the policy, and GPC Chair Laurence Buckman called it a ‘barking policy’. In October 2011, Andrew Lansley apparently performed a ‘U-turn’ on the issue when he spoke to the RCGP Annual Conference, but then subsequent statements and behaviour suggest strongly that he was merely mollifying the GPs, misrepresenting his true intentions. The GPC negotiated a further delay in the policy, with agreement to set outer practice boundaries and to undertake a pilot.
Will the Department of Health and Government waver from their aim? I do not think so. Their intention is to plough on with the policy, dressed up as a ‘reform’ giving people choice. Were they really interested in delivering good quality general practice to the English population, they would have gone about it in an entirely different way.
There is a real risk that we will sleep walk into a change of the structure of primary care provision which will cause real damage to general practice in England.
So can we GPs stop it? I think we can. Not, I would argue, by making representations to the Department of Health or to health ministers; they are set in their minds, they will come back with the usual meaningless spin (‘the people have told us they want choice’), and in the end make it law.
I would propose three main strategies: one is to pressurise the Parliamentary Health Select Committee to investigate this policy before it is made law. So I would invite GPs to sign a petition calling on the Health Select Committee to carry out an inquiry.
Second, I propose that GPs take a public stand. If you think this policy will be damaging (think it through for your own context), then you need to resist it. How? By putting up a sign in your surgery saying that you oppose it. The wording could be something like this:
‘The Government and the Department of Health want to abolish GP practice boundaries. We believe they have ignored the risks this policy carries. We believe the policy will be damaging to general practice in England. For further information, [designated website listing the problems; and/or a handout at reception]. If you agree with our stand, please help by writing to your MP.’
Let your local press know about your opposition, send them a photo of your sign.
In addition, GPs (singly or as a group which would be more powerful) could make an appointment to see their MP to outline the concerns and problems.
Third, educate the press. They have been remarkably compliant so far, but I think this is mainly due to ignorance. We need to pester them to do a bit of homework, to understand how general practice works, to understand the emptiness at the centre of the DH and Government promises.
We are actually in a very strong position. The last thing the DH and Government want is light shone on this policy, because it will expose them. In poker terms, we have a royal flush, the Government and DH have rubbish, nine high.
If you have any suggestions or want to take a more active role in resisting this corrupt policy, contact me at firstname.lastname@example.org or through www.gpboundaries.org. Tell as many of your GP colleagues as possible.