Pressure on government health policy continues - Health Policy Today, 6 August 2008

Tom Smith on a Smorgasbord of health policy issues debated today.  

The Conservatives continue to pile political pressure on the Government, after scoring another political hit with stories of rat-infested hospitals.  The drama of who will form the Labour leadership continues.  And today’s issue of GP reports a poll showing a greater willingness (acceptance?) that GPs will work for private providers, as compared with a similar survey two years ago - as well as new guidance from the Royal College of GPs that says it would be unprofessional of GPs to try to lure new patients from their colleagues, which will work against the policy of competition.  

Tories keep up summer pressure on Labour

A queue of Freedom Of Information requests has seen the Conservatives grab the headlines for the third time this week (and it's only Wednesday).  Today’s follows questions to Trusts about how many times they have called in pest controllers.  The accompanying pictures of brown rats present a powerful image about the cleanliness of hospitals.  The subliminal message is that these are Brown’s rats.  The Tory message is clear: Brown’s ‘deep clean’ (and it was his ) has failed; he promised to fix the problem and has failed.

It is, of course, an absolutely no-win situation for the PM.  He pledged to tackle the problems highlighted by the 2007, taking responsibility; and yet, now, in the light of the FOI answers, he is defended on the grounds that it is the responsibility of local trusts.  It looks as though the Government is trying to have it both ways: when things go well, it is due to excellent central leadership; when they don’t go so well, it is the failure of local management.

The public will no doubt be reassured by a government spokesperson’s response (reported by the Guardian) that ‘the risk to patients was “negligible” and played down fears that infestations of vermin were linked to the spread of hospital superbugs such as MRSA”.

Tories keep up summer pressure on Labour

It is another dreadful news day for Gordon Brown. There is yet more talk about his position.  The Daily Telegraph ‘understands’ that David Miliband has promised former health secretary, Alan Milburn the position of chancellor should he become the next leader.

Related to this, my quote of the day appears in the Financial Times.  As is the current fashion, it is from an unnamed sources – a ‘Whitehall Knight.  Asked about the idea that Blairite ex-cabinet ministers will put forward ideas to fill the current policy vacuum, this sir-person apparently opines that “the country won’t be moved by the clapped-out relics of a dead regime”.

Future GPs will work for private firms

GP magazine today reports that patients will work for private firms. A snapshot poll reports that more than half of future GPs – current trainees – would work for practices run by private providers.  ‘An even higher proportion said they would accept a job in a polyclinic.

‘The survey found that 52 per cent of future GPs would work for a privately-run practice. Only 36 per cent would not consider it.’

An even higher proportion said that they would accept a job in a polyclinic.  

The poll was taken at the BMA’s ‘GPs-to-be’ conference.  One registrar said, “it’s not what I became a GP for, but in the current job climate I might have to”.  The chair of the trainees sub-committee said the figures were a “bombshell” – “‘the private sector will get highly skilled people at the taxpayer's expense”, he said.

‘Most respondents said they would prefer to work in a traditional practice. But they fear the shortage of job opportunities will force them to explore other options.’  

The youngest member of the GPC negotiating team, 35-year old Beth McCarron-Nash pointed out that  GPs themselves are contributing to this change, by limiting opportunities for their younger colleagues.  Without opportunities for partnerships, the opportunities presented by APMS employers seemed “very enticing”.

“I think if you ask most doctors they fundamentally believe in list-based general practice and an NHS that's free at the point of access,' she said. ‘But that doesn't marry up with the job opportunities.”

Royal College say competitive GPs risk being stuck-off

According to GP, ‘GP leaders are on collision course with ministers after the BMA's GPC and Royal College of General Practitioners (RCGP) joint guidance suggested that GPs could be struck off if they actively compete for patients’.  This advice, of course, completely goes against the grain of Government policy, encouraging competition for patients.

In reality, competition will exist - but it will be subtle, suggested in person, rather than an advertising campaign.  GPs leaders will want to avoid negative advertising that could lead to destructive relationships across local health economies.  

The guidance is strongly worded, saying that ‘a GP's behaviour would be deemed ‘unacceptable' if they were to contact prospective patients directly.’

GP magazine reports RCGP chairman Professor Steve Field saying, “On the one hand we would absolutely support information given to patients through websites such as NHS Choices, but it's about objective information rather than saying ‘come down to this surgery because we're better”.