The Progressive

Fight back against scaremongering doctors

This week the British Medical Association starts its campaign against the government's polyclinic proposals. There will be posters and leaflets in every GP surgery. I've already had a preview of what this entails when I visited my local medical centre the other day.

Before I had even checked in, I was urged to sign that BMA infamous petition. Being a bolshie sort of person I declined, pointing out that I was not in the habit of signing petitions until I had acquainted myself with both sides of the argument.This remark produced a disdainful shrug from the lady behind the counter and when I added that I thought that this was multi-GP centre anyway, she retorted rather sharply "Oh no, the new clinics will have dozens of doctors and you'll be lucky to see the same one twice".

The petition form was almost full and I felt my anger rising as I realised that this BMA propaganda exercise was being repeated in surgeries across the nation (which was particularly unfortunate as I was about to have my blood-pressure checked). Quite apart from the ethics of foisting this kind of one-sided material on vulnerable patients visiting a surgery, not properly answered it could only provide another reason for not voting Labour at the next election.

Which brings me to how the government are responding to this insidious campaign. So far I have only seen Alan Johnson's excellent article in the current issue of the Observer. Presumably more will be said by Ministers in the coming days and weeks. But given the emotional pull of the BMA propaganda in the "Trust me I'm a doctor" atmosphere of the surgery this is not enough. The government (or the Party) should be insisting on the surgeries displaying the case for polyclinics alongside the BMA material, to at least give patients the opportunity of considering the pros and cons of this vital issue before making up their minds. Alan Johnson's piece would be a start but even better would be Polly Toynbee's hard-hitting polemic in last Friday's Guardian   

If Whitehall and Victoria Street are reluctant to take this on, how about you dear reader? I have already sent copies of these two articles to my local practice and I would urge you to do the same. The surgeries' response will make a good story about polyclinics for the local newspaper. If you are concerned about how such action will affect your treatment in the surgery, surely the prospect of having the needle plunged in a little more vigorously than usual is a small price to pay for doing your bit for the party.

Physicians, heal thyselves!

“If people think they are going to get their pay cheque and they are going to keep their position irrespective of how good a service they deliver, irrespective of whether they adjust to change or not well you know human nature being what it is they sit back.”

So argued our former PM in the recent documentary The Blair Years. Tony is still clearly frustrated at the resistance of public sector workers to his much-vaunted programme of ‘modernisation’. Yet his remarks show a remarkable lack of self-awareness about his own former conditions of employment as a Member of Parliament. Let’s face it, if you happen to be in a job like Labour MP for Sedgefield (to pick an example purely at random!) it is fairly safe to assume that you will not suddenly find your employment terminated unexpectedly. Since they are largely immune from having their pay cheques withdrawn, it would seem to follow, MPs representing relatively safe seats will have a tendency to sit back rather than deliver a high quality service.

By contrast, we are continually told that today’s citizen is a savvy consumer, expecting to ‘shop around’ and pick the best deal from all the available options. So a business with sacks of correspondence in need of delivery will no longer be reliant on the Royal Mail as the only player in town. Similarly, patients will no longer be encouraged to look automatically towards the local district general hospital for their treatment, but rather compare a range of potential options. The cut and thrust of competition, so the argument runs, is necessary to deliver real choice and, ultimately, better services. It is notable, however, that one ‘service’ has been strangely immune from this logic of modernization, is that of parliamentary representation. New Labour MPs have been rather more keen on introducing competition for other public servants, than on modernizing their own working practices by reforming the system by which they are elected.

For it is an inevitable feature of the voting system used to elect our MPs, based on single-member constituencies, that a lone service provider is granted an absolute monopoly on undertaking parliamentary casework on behalf of his or her constituents. If, from an individual voters’ perspective, your MP is under-performing, unable to deliver on your requirements, or otherwise ill-suited to the task, you are simply stuck with what you’ve got at least until the next election and very possibly beyond. No ‘shopping around’ or sizing up the best provider allowed here. And yet, when it comes to the method of their own election, our members of parliament seem to have pre-determined that any possible reform should begin from the premise that this monopoly remains unchallenged! Why should the service given by MP’s to their constituents remain immune from the logic of reform which is restructuring the way all our other public services are delivered.

This does not mean calling into doubt the daunting amount of casework carried out by the vast majority of MPs, who conscientiously endeavour to represent all of their constituents to the best of their abilities. But if the rest of the public sector must accept a more challenging working environment, why should we not ask the same of our members of parliament? For here, too, increased competition could deliver a level of service more responsive to the needs of the individual service user. If the aim of modernisation is to guarantee that services are oriented around the needs of the service user then surely we should be asking whether introducing choice between parliamentary representatives in each constituency might advance the both the range and quality of choices on offer to the elector?

GP's ask for yet more dosh

A motion put forward to the BMA's conference later this month has suggested that patients should have to pay £20 for routine out of hours care in order to curb demand. Putting aside the fact that most commentators agree the GP's Contract was negotiated overwhelmingly in favour of GP's pockets (and the GMS contract allowed them to specifically opt-out of 24 hour provision of care), why is charging people for out of hours care such a bad idea?

Without stating the obvious, the first is that the NHS is based on the principle of providing care on the basis of need. The motion implicitly suggests that everyone who uses routine out of hours services is a wealthy worker who should be able to pay for their care. But we all know life doesn't work like this. What if you are a full time unpaid carer and the only time you can get away to see the GP is when your partner comes home from work? What if you're a single mum in a minimum wage job? The problem with this is it's policy-making on the basis of the financial choices some big-salaried GPs might have, not on the messy basis of everyday life. And even if you are a city banker, why shouldn't you have the right to use the NHS just like everyone else? Isn't the NHS supposed to be based on the principle of solidarity?

The second problem with this proposal is that it assumes demand for healthcare is too high. It's true that there are hypochondriacs out there and too many people still turn up to the surgery when they have colds or mild flu. But what about the number of women who put off their smear tests because they can't go during the day, or the number of men who will find any excuse not to see their GP? What about the unsympathetic employers who don't allow time off for multiple GP's appointments? We should be making access to out of hours services easier, not harder.

The third reason, is that no matter how hard you try to create exemptions for people on lower incomes, charging for healthcare tends to put them off going for necessary appointments. France had to introduce a system which alleviated the problems created by charging for GP appointments because a significant proportion of people from lower incomes were avoiding seeking care. Evidence from the Swedish National Board of Health and Welfare showed that 3% of the population abstained from seeking healthcare because of the cost of the user charges they have there. The fact is that anyone could end up needing routine out of hours care - illness doesn't respect usual opening hours (and to be honest, many surgeries don't either).

The final reason is that this will increase costs for the NHS in the long-term if people opt to go to A&E instead of paying the £20 for their GP. We know that using hospital care is far more expensive than seeking treatment at a primary care level, it would create more pressure on A&E provision if suddenly the public thought (rightly or wrongly) that they would be charged to see their GP for emergencies.

The Government has been steadily seeking to increase choice and access to healthcare by cutting waiting lists and encouraging service provision to be 'patient-centred'. This latest barmy proposal flies in the face of what patients want and what is best for the NHS.

Clinton puts full weight behind Labour 4th term

I’ve never seen someone flirt with 2000 people at once before. Clinton is the best in world in communicating a difficult political message, and he does it with persuasive charm. What higher endorsement can our policies on climate change and global poverty have, than today’s speech from Bill. And he congratulated us on delivering a strong economy with progressive social reform, in contrast with the US.

He emphasised the work we are doing on improving the environmental standards in new homes. This is especially important for my South Swindon constituency where I am campaigning on the issue.

BC reminded us that we have a position of leadership in the world, that in an ever changing world we need to be the agents of change, and that the progress we are making could be easily reversed. He has seen it himself. He described being heartbroken at seeing the progressive programme halted when Bush took over from him. In a globalised world Clinton emphasised the necessity of working together. He reflected America’s disappointment at the way the Tories under Cameron have turned their backs on cooperation with the US by praising TB for maintaining a sometimes uncomfortable alliance.

After this speech it would be unfeasible to see any cooperation with a Cameron government. Support from Britain for his work on poverty and AIDS would rely on a 4th term for Labour.

NB. A quick comment on the Secretary of State for Health's speech to conference. It was a very different style. Patricia Hewitt was away from the podium, conversational and well received - despite the obvious differences of opinion there are over NHS Logistics.

Clearly we need to do some more talking on this. With £ 1 Billion at stake for the NHS front line it's a crucial debate.