Guest editorial Wednesday 18 May 2011: Two GPs and a bit of common sense

This guest editorial by Julian Tyndale-Biscoe, MD of InHealth Communications, wonders whether citizen panels offer a viable workaround to the questions of clinical commissioners’ accountability and politics.

I know two GPs who are polar opposites of each other. They work less than a mile apart.

One is a dyed-in-the-wool socialist. He has worked in the East End of London, and is motivated by the need to mend society’s stricken. He rolls his eyes when he has to tell a young mum that smoking isn’t good for her baby, because somehow the message hasn’t got through. But that’s his job. It’s about giving something back.

He would find a lot of common ground with Dr Clare Gerada.

The other GP takes more of a free market approach. He believes that the care he provides has a value, and that it needs to be rationed – there are only so many hours in the day. His answer is to charge patients for each visit. It’s about understanding the value of treatment.

He would find a lot of common ground with Dr Luke Twelves.

The change consensus
They both believe the way care and treatment is delivered needs to change, and have ideas for putting things right. Each would take a different approach: one influenced by their political ideology.

The reality is that although we talk about stopping the NHS from becoming a political football, the NHS is wrought with politics. Devolving power to GPs sounds great in terms of decisions being made by the clinicians on the frontline - but they are human. Their opinions will have been shaped by life experiences.

Not all will be able to make unbiased, a-political decisions - and ultimately, quite rationally, they want to protect their livelihoods.

Witness the furore that often erupts when other providers are commissioned to deliver services by PCTs. More importantly, there is a wide variation in the quality of care that GPs currently deliver, as the recent Kings Fund inquiry noted.

What Lansley has missed (in addition to the blind-spot over his ability to communicate his reform package) is that his army of knights in shining armour consists of people who are just like everyone else.

PCTs may have been havens for political correctness, but at least they were attempting to be impartial and unbiased.

The lay of the land
Lansley is now paying lip service to patient involvement by suggesting that GP consortia (or whatever they will be called) should have lay membership.

Perhaps the answer is more bold and radical. It’s one that Dr James Kingsland has been talking about recently.

Dr Kingsland says that GP consortia should be accountable to a citizens’ panel, made up of a decent cross-section of the local population – not just the same old faces who will inevitably pop up in GP consortia.

At least some of the politics of care will be wrested away from GPs, and they will have to account for decisions they make in terms of quality improvement.

Julian Tyndale-Biscoe is Managing Director of InHealth Communications