Peter Bailey: poisoned chalice

It is now just over three weeks since I saw my last patient, hung up my stethoscope, and retired. A GP with time to think! Just imagine what might happen. Among the first fruits of this contemplation was the personal view of the Health and Social Services Bill that I submitted to the BMJ which was published under the tag “Primary Care Duped.” The press release prior to publication alerted the media to my article and I had calls from the BBC, the Guardian, the Morning Star, and from Sky television. Just before a live TV interview with Rupert Murdoch’s lot, I had a call from Mr Lansley’s office, asking me to ring as soon as possible. Straightening my tie and pushing a copy of Gray’s Anatomy down my trousers in anticipation of a thrashing, I phoned. A very polite young man, clearly weary from the burden of dealing with waves of opposition to the bill, gently told me that I had misunderstood key elements of the bill. In particular, he assured me that PCTs were not really being abolished, that the managers who staffed them were not really leaving, and that the transfer of financial responsibility to Clinical Commissioning Groups and GPs was just an administrative device to ensure that PCTs became more responsive to clinical advice.  The managers who were previously PCT employees would transfer seamlessly to the Clinical Commissioning Groups and no one would really notice any difference.  And no, the private sector would not be providing all the commissioning support.

Silly me. I had got it all wrong. I felt reassured. The sky wasn’t falling in after all. Dedicated public servants with lifelong experience of administering the NHS and with the ideals of the service written through their bones were not being lost and the new structure of the NHS could save £20 billion by teatime.

Chastened by my mistake I thought I ought to pay more attention. Where better to look at the detail of the bill than on the parliamentary web site.  Here I found a helpful summary of the bill’s key provisions.  Five bullet points. Number five: The bill….

“cuts the number of health bodies to help meet the Government’s commitment to cut NHS administration costs by a third, including abolishing Primary Care Trusts and Strategic Health Authorities”

Are there many others like me, suffering nystagmus from the spinning that is going on?  What about the attendees of Tuesday’s summit of believers (and some quietly-spoken dissenters) at Downing Street? Had they made any headway in persuading the prime minister and health secretary that there just might be some problems with the bill? No. The prime minister said that the legislation was progressing nicely, was just what the doctor ordered, and that the meeting had closed without any further changes being needed.

Perhaps I should listen at first hand, I thought, so I tuned in to prime minister’s questions, for a higher level of debate in our fine parliamentary democracy. I found myself in complete agreement with the prime minister as he argued for choice for patients, greater involvement of the voluntary sector, and more focus upon public health, but I heard nothing about my concerns that the very bodies that might deliver this were being abolished.  The leader of the opposition attempted to give an example of fragmentation of commissioning but the “debate” was conducted in the atmosphere of a rowdy playground fight between the school bully and the geeky kid with howls of encouragement from Year 11 (remedial group) all baying for blood.

Last night there was a debate in the Commons about the spurious issue of the Risk Register. Where is serious discussion taking place? Does anyone out there care? Is it all just politics?

Perhaps it is time for GPs to down tools on commissioning? If the RCGP poll is to be believed and if the popular opinion polls are right, GPs would have the support of their patients and their clinical colleagues in all disciplines if they said that their day job was more important to them than propping up the unworkable bill.

My passion throughout my 28 years as a GP was for the consultation. The quiet space I created for each person who came through my door with a concern, a worry, or a question.  Does anyone realise how valuable that moment is?  Where in all the maelstrom of change is the preciousness of the impartial GP listening with all his or her might to the patient given honour, space, time, and resource?  It is the consultation that is the beating heart of the NHS; it is from the consultation that everything else flows.

Give us back the consultation. Take the poisoned chalice of running the NHS away and let us return to giving advice in our spare time to managers who know what they are doing.

And if they won’t take it back, fling it to the floor.

Peter Bailey is a retired general practitioner, Cambridge