November 2010, Week 3


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Sat, 20 Nov 2010 14:56:11 -0500
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British MDs Warned to Expect Unrest Over Healthcare

Exclusive: GPs'[general practioniers]leader
criticises Lansley's reform plans and predicts
that doctors will face demonstrations by angry

By Denis Campbell, health correspondent
Guardian (UK)
November 19, 2010


Doctors face demonstrations outside their surgeries and
questions about their high salaries by angry patients
because of the government's radical NHS shakeup, the
new leader of Britain's GPs warns.

Desperate patients denied life-extending drugs or
surgery for their ailments may also vent their
frustrations on GPs, because they are due to assume
control of deciding how £80bn-a-year of health funding
is spent, said Dr Clare Gerada, who takes over tomorrow
as chair of the Royal College of GPs.

In an outspoken attack on health secretary Andrew
Lansley's NHS reform plans, she also hit out at his
decision to transfer responsibility for rationing
access to treatment from the National Institute of
Health and Clinical Excellence (Nice) and primary care
trusts to GPs in England from 2013.

"At worst, the negative impact for GPs could be
patients lobbying outside their front door, saying,
'You've got a nice BMW car but you will not allow me to
have this cytotoxic drug that will give me three more
months of life,'" Gerada told the Guardian in an

"I'm concerned that my profession, GPs, will be exposed
to lobbying by patients, patient groups and the pharma
industry to fund or commission their bit of the
service. There could be letters from MPs and patient
groups, and begging letters from patients."

Making GPs "the new rationers" of NHS care could ruin
the long-established bonds of trust between them and
their patients, undermine "the sacredness of the
consultation" and turn patients into little more than
"customers" who shop around trying to get the best
treatment for their ailment, Gerada added. Inherent
conflicts of interest in the new system could also
jeopardise GP-patient relationships, she warned.
"Patients might think that the decision made about
their healthcare will be based on self-interest - GPs
saving money for themselves rather than spending it on
patients." Certain treatment decisions, and a GP
consortium's need to balance its books "could be

The NHS will not survive intact Lansley's plans to
scrap many existing NHS bodies, introduce GP
commissioning and push through greater competition
between hospitals, she predicted.

"I think it is the end of the NHS as we currently know
it, which is a national, unified health service, with
central policies and central planning, in the way that
[Aneurin] Bevan imagined," said 51-year-old Gerada, who
represents Britain's 40,000 family doctors. Lansley's
shakeup will lead to a much greater role for private
healthcare companies, the likelihood that England's
health system will look more and more like America's,
and GPs being blamed for things such as the NHS's
inability to cope with a winter crisis, long waiting
lists and the decommissioning of services to save
money, she added.

GPs in their new role will bear the brunt of the NHS's
need to save £20bn by 2014, which will lead to far more
"postcode lotteries" in services such as IVF, expensive
drugs, and even access to particular hospital
specialists such as surgeons and gynaecologists.
Leaving each of the new GP consortiums to decide
individually what treatment should or should not be
available locally will lead to disputes over access to
care. "I don't understand why he's putting in a system
that in Scunthorpe you can get a different service to
Scarborough, when we've spent the last 60 years working
against that", said Gerada. Her comments are the most
detailed criticism yet made by any senior doctor of
Lansley's plans, which have caused serious unease among
medical organisations.

John Healey, Labour's shadow health secretary, used
them to portray Lansley as dogmatic and out-of-touch.
"These criticisms from an influential GP again reveal
how Andrew Lansley is failing to listen to the warnings
of doctors, nurses and health experts to slow down on
his high-cost, high-risk plans," said Healey.

"With plans for the biggest reorganisation in the NHS's
history, it is also becoming clear that he is running a
rogue department, operating in isolation from his
colleagues in government."

Healey echoed Gerada's concern about patients in future
questioning GPs' motivations. "Patients will worry
about treatment decisions - are they being taken in
their best interest or the best interest of the GP
consortium's budget?"

The British Medical Association warned the changes
could see the NHS fragment. Dr Laurence Buckman,
chairman of the BMA's GPs committee, agreed with some
of Gerada's concerns. "GPs are fully aware of the
difficulties facing the NHS as we enter a very
difficult financial period and that tough decisions
will have to be taken. The BMA has repeatedly expressed
its concerns about the timing of the white paper
proposals as well as the potential risks and benefits
that may result from the government's plans," he said.

Prof Chris Ham, chief executive of the King's Fund
health thinktank, endorsed Gerada's view that Lansley
should move more slowly. "With international evidence
this week showing our health system performing well
compared to other countries, and the NHS facing
significant financial pressures over the next few
years, evolutionary change building on existing
arrangements offers a more promising route to improving
the NHS than radical structural changes," he said.

A Department of Health spokeswoman said: "Our reforms
will indeed mark a new era for the NHS - one where
patients and clinicians are at the heart of the
service. Our reforms aren't an option, they are a
necessity in order to sustain and improve our NHS. The
reforms are far-reaching but they also build upon
existing designs. We share a common goal with the RCGP
that we all want patients to get the best health and
care services."

But she added: "We understand concerns around
implementation. That's why we have consulted
extensively on our plans, and have already announced a
programme where GP consortia can start testing white
paper principles. We will announce the outcome of the
consultation later this year. We believe that both
purpose and pace are vital to improve services for


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