2. Burnham & the King’s Fund

The following is the text, with minor variations, of an article first published in Pulse on 16/11/12.

On September 17, 2009, Andrew Burnham, then Secretary of State for Health, travelled to the King’s Fund, England’s premiere health think tank. The visit was trailed in press articles the day before. Andy Burnham would say, “In this day and age, I can see no reason why patients should not be able to choose the GP practice they want. Many of us lead hectic lives and health services should be there to make things easier.” And: ‘Andy Burnham will say the abolition of GP practice boundaries will improve the “patient experience” and make the NHS “great” again.’ And: ‘Under current rules patients can only sign up with a GP within defined boundaries close to their home. This means that less well-off patients are forced to sign up with surgeries in deprived areas, and are barred from using doctors in more affluent areas unless they live in a mixed-income area.’

The speech to the King’s Fund gathering lasted about 22 minutes, and covered a number of different issues (links provided on blog, see below). About one minute was given over to the plan to abolish GP practice boundaries. Burnham said, ‘I want the best to be available to everyone, not according to where they live. This means extending choice within primary care. Too often, people’s choice is unnecessarily limited by practice boundaries. So, with the profession, I want to open up real choice in primary care. Within the next twelve months, I want to abolish practice boundaries for patients to allow people to register with the surgery of their choice.’

At the end of the speech, there was a panel discussion. As far as I can make out, the GP boundary issue was not discussed. In his summing up, the then King’s Fund CEO Niall Dickson (now Chief Executive of the GMC), was quoted as follows: ‘The vast majority of patients are more than happy with their GP, but the restriction on where they can register is an anachronism and the government is right to sweep it away. There are details to be worked out, but it should not be impossible.’

I was bewildered when I read all this. In our experience, looking after patients at a distance from the practice just did not work, and was at times dangerous. We had, in essence, been carrying out a pilot on this for over 20 years. It was clear to me that UK primary care is a complex technology that is locally based. Geography plays a very central role in its ecology. In a myriad of ways, on a daily basis, it was clear that it functions because it is local.

What was wrong with these people, this man who was Secretary of State for Health, this man who was CEO of a respected think tank? What was wrong with this think tank that it could let these assertions go unexamined, unchallenged? Had they left their critical faculties at home on that day? What was wrong with the journalists, who appeared so credulous and uncritical?

There are two very basic facts that make this policy quite foolish. First, the fact that looking after people at a distance does not work. No amount of spin, of smoke and mirrors, can change this. Oh, yes, it will work for people who are well and do not need attention, but for those who are ill, distance is a barrier to care. Second, GP practices are working at full capacity already. There is not significant spare capacity to absorb people who want to take advantage of Burnham’s offer of ‘real choice’.

And this is just the tip of an enormous iceberg.

(Oh, another fact: Andy Burnham has no experience, not 5 minutes, of working as a GP, as a health care assistant, or any type of health care professional. Why, pray tell, is this man deciding anything at all?)

In December 2011, by now the opposition health spokesman, Burnham was quoted as saying that ‘as a principle, practice boundary abolition is unanswerable’. I have tried, with some persistence, to arrange an interview with Mr Burnham, but without success. Is this what he means by ‘unanswerable’?

Next week, we turn to Andy Burnham’s ‘consultation’ with the English people: was this a deception?

For notes and links, click here. I advise strongly that you look at these.

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