David Cameron launches campaign to save 1,600 GP surgeries

The 10p tax band and post office closures are the two trickiest issues for Labour on the doorsteps at the moment.  David Cameron aims to add a third today with a warning that 1,600 GP surgeries are under threat from Government plans to create a national network of "polyclinics".

The Government believes that the wider range of services that "polyclinics" will provide - including pharmacy and diagnostic services - as well as longer hours will compensate for any decline in the number of local surgeries.

Speaking to the King's Fund Mr Cameron will say: "Communities which have lost their post office, their local shops and their local police station, are now going to lose their doctor."  See Telegraph report.

Related link: Julia Manning's campaign to 'Give GPs a break'

3.15pm: John Crippen on CentreRight - Polyclinics - supermarket medicine for the poor

Comments

[Tanuki]

This could play well in rural areas, specially if combined with extending GP surgery hours.

[EML]

Not a bad idea, attacking the Government on a breadth of issues rather than banging on about tax all the time!

If he could offer a concise alternative to polyclinics or the status quo - which the Government obviously thinks isn't working - then all the better. Perhaps something for later in the year though.

[Sammy Finn]

Good politics, yes, but good patient care? I am not convinced.

There may be a good case for larger clinics with more services.

[Geoff]

I totally agree with this petition. We have to get back control of our opening hours.

The contract changes the government is introducing will mean in my practice I have to work 2 extra evenings AND a saturday morning just to stay at the same salary. We have to get back control of our hours so we can end this nonsense. SUPPORT THIS PETITION

[Jeremy Lefroy]

We need both small practices and large. Small practices are essential for people - often, but no exclusively, the old and vulnerable - who want to see a doctor who knows them, their family and their medical hsitory.

My wife works in a single-handed practice (job sharing) in inner-city Stoke-on-Trent. When surveyed, almost all her patients want the practice to remain that way. The close relationship with their doctor far outwieghs any inconvenience from having to travel up the road for an XRay or other tests.

The practice is popular and it has more people applying to join than they can sensibly accomodate.

We believe in a patient-centred NHS. It is clear that very many people prefer to be in small practices. We must therefore resist any proposal which has the effect (whether intentional or not) of closing down popular small practices.

That does not mean we should always oppose polyclinics. But if it means that popular small practices have to close or be amalgamated to make way for them, we should resist strongly.

There is further information on an IPSOS MORI poll conducted about small practices on my webiste - www.jeremylefroy.info/blog

[Jeremy Lefroy]

We need both small practices and large. Small practices are essential for people - often, but no exclusively, the old and vulnerable - who want to see a doctor who knows them, their family and their medical hsitory.

My wife works in a single-handed practice (job sharing) in inner-city Stoke-on-Trent. When surveyed, almost all her patients want the practice to remain that way. The close relationship with their doctor far outwieghs any inconvenience from having to travel up the road for an XRay or other tests.

The practice is popular and it has more people applying to join than they can sensibly accomodate.

We believe in a patient-centred NHS. It is clear that very many people prefer to be in small practices. We must therefore resist any proposal which has the effect (whether intentional or not) of closing down popular small practices.

That does not mean we should always oppose polyclinics. But if it means that popular small practices have to close or be amalgamated to make way for them, we should resist strongly.

There is further information on an IPSOS MORI poll conducted about small practices on my webiste - www.jeremylefroy.info/blog

[Hardcore Conservative]

Please do not feel sorry for general practitioners. If they oppose anything it is most likely on the grounds of affecting their salaries rather than affecting patient care. There are still a few GP’s who work out there with truly altruistic motives but most are driven by personal income generation. They rejected providing an out of hour’s service on “principle” because they didn’t want to be “tired” doctors during the day. Money had nothing to do with it according to them. But given that some out of hours providers pay between £70 and £100 an hour, I have often watched the spectacle of my colleagues stabbing each other in the back trying to get these out of hours shifts, often “working” (I use that term loosely) overnight, going into their surgeries the next day and then coming back for another overnight shift. Tiredness it seems is not now such an important issue after all.

It is especially attractive to work overnight as a GP because other health care professionals have been pulled away from their usual roles and forced into the out of hour’s service, because GPs originally said they wouldn’t do it. These GPs can now get the other professionals to do their jobs for them, for a fraction of GP pay, while the doctor leads an easy life raking in the money.

Practice meetings are always a giggle as well. Supposedly professional learned people squabbling like kids over money: “But I want more money”; “It is not enough for doing that” are the often heard cries. So if polyclinics are opposed by doctors it is probably a good thing for the patient. I can assure people that if doctors found that polyclinics would help them gain more quality point’s thus maximising income generation, all “principled” opposition would rapidly disappear. Just like it did over the provision of out of hours care.

In many areas doctors surgeries are close together anyway, often opposite each other, so merging them would not create the hardships of travelling that have been advanced as a reason to stop the proposal. A polyclinic that offers a “one stop shop” is surely better than the fragmented service that is currently offered.

For example, old Mrs Smith comes to see a doctor at her local surgery, not her registered GP because this surgery, like so many others, no longer has personal lists. This is the third time that Mrs Smith has visited her surgery for this problem and has seen three different doctors. She doesn’t mind as the surgery is very local to her. Following the latest consultation the doctor wants Mrs Smith to have a blood test and an X-ray. The problem is that the surgery is not funded for a phlebotomy service, and in order to “make a stand” against the PCT, the surgery has an absolute zero tolerance approach to blood tests. Mrs Smith has to go to the pathology department at her nearest hospital, which is a 20mile round-trip, for her blood test. While there she innocently asks if they can do the X-ray for her at the same time. Mrs Smith endures a 10 minute lecture on the “lack of resources”, the way waiting lists work and that exceptions cannot be made. A simple “no” would probably have sufficed.

Mrs Smith then makes a separate 20mile round-trip in a weeks time (if she is lucky) to the X-ray department at the same hospital, that is situated opposite the pathology department, and gets her X-ray.

Mrs Smith now curses herself, had she hung on for another six months she could have seen a doctor at the new polyclinic that was opening 2 miles away from her old surgery. She could have left the doctors consultation room, popped next door and got her blood test done, and then walked down the corridor for her X-ray. Mrs Smith liked her old surgery, but thought that travelling 4 miles in a day and getting everything done in a morning was better than travelling 40miles and waiting a week.

Then she became angry that a man called David Cameron was going to stop this because the doctors had been moaning again: “We like things the way they are”.

I bet they do.

[John]

I think "Hardcore Conservative", made many a valid point and I like the idea of primary care, 8am to 8pm, seven days a week with pharmacy and diagnostic services but I strongly suspect that the polyclinics will be a very crowded place with long waiting times.

Come winter time it could be filled with infectious people spraying their virus and because of all the services available and limited seating such a crowded place could become a breading ground for virus infections and likely foreigners will walk in wanting to see a doctor.

With the present GP system the doctor will call on someone feeling ill and will make a diagnosis but with the polyclinic a very infectious person may choose by virtue of all the services made available to use the polyclinic come what may.

Also women having a baby like to see their own GP and without a GP service a burdensome visit to the polyclinic will be her only option apart from a journey to the A&E.

In the long run it's six of one and half a dozen of the other and there is a lot to be said for the GP service that makes house calls when you feel much too ill to leave your sickbed.

[David Cooper]

[email protected]: I could not have put it better myself by reference to my wife's experience as a sole GP practitioner in Wolverhampton. It seems to me that the real driving force behind all of this is central control. Polyclinics may have their place, as Dr Crippen has described elsewhere today, but not at the expense of treating patients like supermarket shoppers and qualified professionals like glorified box tickers.

[Hardcore Conservative]

“….I strongly suspect that the polyclinics will be a very crowded place with long waiting times”.

That alas will be their Achilles-hill. No system is perfect and they will only work if they see the appropriate people and are properly and adequately resourced, with the right infrastructure. I have a horrible feeling though that under this government the PCT’s will slowly siphon off money from these centres and we will, as always, be left with a first class idea with third class implementation overseen by complete dimwits. This in turn risks discrediting this laudable idea.

It would be nice if they trialed a few polyclinics first, ideally under the stewardship of a conservative government, ensuring that we had proper value for money while leaving clinical professionals in the driving seat. I am rather disappointed that Mr Cameron has dismissed the idea out of hand.

[Opinicus]

@Hardcore Conservative

I see you have entered your anec-dotage

Exactly what is wrong with doctors earning money? Do you not want Doctors to be bright people? Bright people have a range of careers open to them and will mostly choose the one that betters them best. This is known as a)human nature and b)the law of the market. As a "hardcore Conservative" this ought to be obvious to you. Bright people not motivated by money have usually become priests not doctors, perhaps you are confusing the two. Or you have read too many novels by Galsworthy or similar.

What is wrong about practice business meetings discussing money? Name me another business meeting that doen't discuss money - even Cathedral chapters or the board of Oxfam.

There's an awful lot of hypocrisy talked about health care. Its a business whether it is nationalised or private. It needs to attract and keep staff. Yes doctors have an advantage in that there are so few of them 1 for every 6000 patients as opposed to 1 for every 1600 in Italy or the USA. But its a government induced scarcity and its being eroded by immigration from the EU.

GPs are the efficient part of the health service. They screen out 88% of primary consultations very cheaply and cost effectively, allowing only 12% through to the infinitely more expensive and sclerotic secondary sector. This triage is a high level function, managing uncertainty always is. By the time a GP makes a cardiology referal it is very likely to be something wrong with the heart. Compare France where a patient can rush to their cardiologist have a battery of expensive tests before a tentative suggestion that they should try a gut doctor instead. GPs are what keeps the NHS cheap per capita.

Yes GPs are also small businessmen but what has struck the government like a bolt of lightening after the new contract is the revelation that this means that they have a group of doctors who will adapt to any request if it is funded. After the sclerosis , bloodyminded, small minded politicking of the average hospital consultant this is a breath of fresh air. Why is healthcare being devolved to GPs from secondary care the cornerstone of current health policy, because a) it is cheaper and b) they can get it done far more efficiently by a doctor used to reviewing his patients next week rather "than come back in three months".
The tariff for anticoagulation in my local hospital is £1600 per patient per year. I do it for £200 but pace "hardocre Conservative", both he, the government and anyone else can whistle Dixie before I'll do it for free.

[Hardcore Conservative]

Jonathan @ 0011, a few observations:

I have not suggested that doctors should not be given a fair days pay for a fair days work. But doctors earning over a £100 per hour of tax payers money during an OOH shift for doing little work is obscene.

I am a “Hardcore Conservative”, but you have made the elementary mistake of linking my traditional hardcore conservatism with the repugnant conservatism we endured during the 80’s and 90’s. The same repugnant conservatism that vilified poor people, the working class, single mothers and those who could not afford exotic holidays or private health care. That conservatism has kept us in opposition for 11 years (and counting).

My kind of conservatism is about true equality for everyone, justice, making a stand against hypocrisy, and above all showing compassion, exercising responsibility and having a sense of duty.

No one is suggesting that doctors shouldn’t be “bright people” although having worked with some GP’s I do wonder sometimes. There was a time, however, when general practitioners (this is who I am reserving my criticisms for in this thread) entered the profession motivated by duty and humanitarian concerns, not money. A doctor solely motivated by money is likely to make a poor humanitarian, and poor humanitarians make poor doctors. They do, however, make good politicians and most GP’s now have more in common with politicians than they care to realise, with all the amoral traits that comes with it.

I consider treating patients a privilege and I have never done so for personal reward or gain. I am in the minority sadly. I can agree with the rest of your thread up to a point at least, although it’s worth remembering that we are not dealing with stocks, shares or sacks of potatoes we are dealing with human beings.

The main thrust of my argument is that many GP’s have become greedy hypocrites and I stand by that absolutely. As I have alluded to a small number still have a true sense of duty, but many are motivated by personal gain and patients are seen as an inconvenient nuisance.

I cannot feel anything but contempt for my colleagues when I hear them opposing moves to make a patients life easier, on the grounds that it is not good for patients, when what they really mean is it will make life more difficult for the GP to earn another wad of cash to pay for that exotic holiday or barn conversion.

You have argued your case like a true politician.

Think about it.

[Opinicus]

@"hardcore" Conservative
The "obscene" £100 ph you quote for OOH calls compares pretty well with the plumber who charges me £88 ph +VAT at the same time. Please remember he is dealing with widgets and u-bends not with human beings.
If you think OOH doctors do "very little" it is clearly some time since you did a shift as one.
You are alone in your monkish vocation to medicine, the rest of us have wives and children to feed, educate and clothe and yes, whisper it softly, the occasional exotic holiday. I bet there's no one else so wicked on this site as to have one of those.

[Opinicus]

@"hardcore" Conservative
The "obscene" £100 ph you quote for OOH calls compares pretty well with the plumber who charges me £88 ph +VAT at the same time. Please remember he is dealing with widgets and u-bends not with human beings.
If you think OOH doctors do "very little" it is clearly some time since you did a shift as one.
You are alone in your monkish vocation to medicine, the rest of us have wives and children to feed, educate and clothe and yes, whisper it softly, the occasional exotic holiday. I bet there's no one else so wicked on this site as to have one of those.

[Hardcore Conservative]

The difference between a plumber and a doctor is this – you chose to pay for a plumber privately and that is your choice (you may also be able do the job yourself), a doctor is paid from the public purse and wage rates need to strike a balance between this and the need to reward GPs fairly.

I am not monkish in my vocation and I am very familiar with OOH work hence why I see doctors behaving as they do. Many GPs doing these OOH shifts turn up late, and are reluctant to see patients when they finally arrive. Most milk the system for all its worth and rather disarmingly admit that they are there to make hay when the sun shines!

What I cannot stand is the hypocrisy. If my colleagues are in the game to make money then they should be honest enough and say so, but be prepared to compete openly with the private sector and accept the financial risks of doing so. This personally is anathema to me as I believe that health care should not be a business but a service based on humanitarian need. The public purse is not a bottomless pit.

I will say this for the final time; GPs should stop pretending the innovations to make patients lives easier are about compromising care, when it is really about compromising doctors control and ability to grab ever increasingly large amounts of money from the taxpayer.

[Pett]

Hi there,
Super post, Need to mark it on Digg

Thanks
Pett