Last year the Archbishop of Canterbury attacked what he described as "the quiet resurgence of the seductive language of the deserving and undeserving poor".
The pressure to make huge savings within the NHS, coupled with the commissioning agenda and the introduction of private competition to that process could see the deserving and undeserving poor joined by the deserving and undeserving sick. This can't be right. After all, no one chooses to be sick.
When I hear insulting terms like "frequent flyers" being used to describe people who are sick and need our care and attention, I worry that the pressure to make savings and be the financial managers of care is compromising the relationship between clinician and patient.
The problem here is not placing GPs at the heart of commissioning, it’s allowing commissioning to compromise a GP’s responsibility towards their patients
We're already accused of making "inappropriate referrals" whenever we put what's best for our patients above what's best for saving money. But once we start sacrificing long-term benefits for the patient in favour of short-term savings we will lose the trust of our patients to do what is right for them.
The problem here is not placing GPs at the heart of commissioning, it’s allowing commissioning to compromise a GP’s responsibility towards their patients.
We mustn't allow ourselves to be compromised. Our first responsibility must be to the patient in front of us. Our next is to the patients in the waiting room. After that comes our responsibility to those on our list. And then to our local community, and finally the wider population. In that order.
People often tell me that GPs make good commissioners because of the population-focus we bring to care. First and foremost though, GPs must be allowed to be good GPs.
Part of that is understanding how we use resources fairly and effectively – or good commissioning.
But being a good GP is not about choosing between the best interests of our patients and those of the nation’s purse. Governments should have ultimate responsibility for decisions about rationing health care, not GPs – guided and advised by us, for sure, but finally the decision must be taken by a publicly accountable body, not an individual doctor or a group of doctors.
Of course, it's important that GPs are mindful of resources. We have a responsibility to spend the public's money carefully and wisely, but we must hold fast to the principle that good health care should be available to all.
I worry we're heading towards a situation where health care will be like a budget airline. There will be two queues: one queue for those who can afford to pay, and another for those who can't. Seats will be limited to those who muscle in first. And the rest will be left stranded on the tarmac.
But we shouldn’t allow the public to be deceived into believing that this will bring about the savings to the system that are being demanded.
If we are to make these savings in times of austerity, we need to do so as one NHS. Collaborating, co-operating and innovating – not competing against each other.
As long as we are allowed to do this, and more importantly what we know to be right for our patients, we will keep their trust.
Dr Clare Gerada spoke at the Nuffield Trust and The Royal College of Surgeons debate: Could the NHS further restrict the services it provides to offer a core package of services for all patients?
Dr Clare Gerada is Chair of the Royal College of General Practitioners. Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors’ own.
Comments (3)
When I trained as a Doctor I learned that GPs knew very well which Consultant provided the best service for the patient in front of them. After all, GPs have to cope with the failures as well as enjoying the successes. Most still have this role for their Private Patients. The conflict of interest comes when they are obliged to allow their patients to be seen by somebody they may know to be second best (or worse!) but have no alternative either because of Politically motivated targets or through lack of appropriate skills in the locality. The change I have seen in the NHS in the 45 years I worked in it was that, all too often, good patient care was achieved despite the NHS, not because of it. As a Hospital Consultant I am certain we will not reverse this dreadful trend UNTIL the GPs take back control. In my view, nothing is more urgent and every week that goes by without this reform betrays our patients and ourselves.
"The problem here is not placing GPs at the heart of commissioning, it’s allowing commissioning to compromise a GP’s responsibility towards their patients."
How exactly is this going to happen? Can't GPs do two things, and not even at once? My GP is also a Police Surgeon. Does this mean that the treatment that he provides is compromised in some way?
"But once we start sacrificing long-term benefits for the patient in favour of short-term savings we will lose the trust of our patients to do what is right for them."
Why would GPs do this? Really, what is going to force them to make decisions that do this? Why isn't it possible to commission to achieve long term benefits within resources that are available? After all, whoever is responsible for commissioning is going to have to do it, so why don't GPs want to be involved?
"We mustn't allow ourselves to be compromised. Our first responsibility must be to the patient in front of us. Our next is to the patients in the waiting room. After that comes our responsibility to those on our list. And then to our local community, and finally the wider population. In that order."
Aren't GPs compromised now? Do GPs fight for their patients when PCTs refuse to pay care, and so demonstrate that they are putting patients first? Mine certainly hasn't, and given that I've complained about this and the complaint has been answered by the head of the surgery, meaning that at least one other doctor is aware of the issue, it appears that his colleagues aren't prepared to fight for me either. At least once GP commissioning is in place I'll be able to speak face to face with one of the people responsible for commissioning my care and demand that he/she explain and justify the services that they have commissioned. Try doing that at the moment. It's not like PCT Board Members publish their contact details - not even email addresses.
"Governments should have ultimate responsibility for decisions about rationing health care, not GPs – guided and advised by us, for sure, but finally the decision must be taken by a publicly accountable body, not an individual doctor or a group of doctors."
This is probably where all the trouble lies as http://www.guardian.co.uk/society/2010/nov/19/doctors-warned-expect-unre... seems to show. GPs just don't want to be involved because that will mean taking responsibility for their actions and for having real responsibility for their patients' health, including fighting for an appropriate level of funding. Why accept responsibility when the current system allows you blame someone else?
I hope that Clare will be back to respond to these points.
This bill has caused so much resistance amongst clinicians, that all its good intentions are never going to be realised. One thing is for sure, for the first time in a very long time,there is an air of uncertanity in the NHS.
The bill is a solution to a problem that does not exist. There is overwhelming evidence which shows that patients rarely exercise choice. They prefer to have their most local health facilities improved, rather vthan be shipped to a willing provider elsewhere. PCT's and SHA's had become a white elephant and needed to be cut down and streamlined. The government would have done well to focus on improving the current service, rather than trying to completely overhaul the system. there are areas in need of improvement, just like there are areas where the NHS is doing really well. The risk is this complete top down restructuing is going to disrupt services that had been functioning well, while not improving services which were lagging behind.
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