Dr Roy Macgregor isn’t the only GP with severe doubts about the merits of the health bill going through Parliament. According to a survey carried out by the doctors’ newspaper Pulse, more than half of GPs have no confidence in the health secretary, Andrew Lansley. Meanwhile, a poll at GPonline is showing that 65 per cent of the profession think GPs should take industrial action against the proposed reforms. So much for the government’s claims that there is ‘overwhelming enthusiasm’ for their plans among GPs.
The reasons for doctors’ opposition to the health bill are no secret. According to a survey of 1800 of its members carried out by the Royal College of General Practitioners in January, 73 per cent of GPs believe that introducing competition between healthcare providers would not result in better treatment for patients; 58 per cent don’t believe it would even reduce bureaucracy in the NHS; and 61 per cent disagree with the general direction of the reforms.
An Ipsos-MORI survey of doctors published this week by the British Medical Association found similar results. More than 60 per cent of the 1645 respondents said that the reforms would mean spending less time with patients, which only 1 per cent thought a good thing. Two-thirds said that putting doctors in charge of commissioning would increase health inequalities, and nearly 90 per cent said they thought that increasing competition between healthcare providers would lead to ‘fragmentation of services’. It may not sound like it, but this is strong language: for doctors and nurses well versed in the importance of ‘continuity of care’, ‘fragmentation of services’ is one of the worst things that can happen.
The BMA also identified ‘the top five barriers’, in the opinion of doctors, ‘to the government’s reforms in improving outcomes for patients and the public’. Top of the list is the speed at which the changes are taking place, followed by the potential conflict of interest for GPs as both commissioners and providers of NHS services, ‘budget pressures due to public spending constraints’ and the ‘increased focus on competition’.
Monitor, currently a regulator of NHS foundation trusts, is having a makeover and will emerge in 2014 as the NHS competition watchdog along the lines of Postcomm, Ofcom and Ofwat. Its newly appointed chairman, David Bennett, a former adviser to Tony Blair, recently told the doctors’ newspaper GP that, contrary to assurances given by the NHS chief executive, David Nicholson, he would indeed oversee the introduction of price competition within the NHS. ‘I understand why people are nervous about price competition,’ he said. ‘But over time there will be areas where it is useful.’ This caused widespread consternation among doctors, on the grounds that they should be trying to provide their patients with the best care possible, not simply the cheapest, and has led to a hasty intervention from the health secretary, who said today that the bill will be amended to rule out price competition.
Whether or not this is enough to reassure doctors about the reforms remains to be seen. And whether or not GPs will actually go on strike will be decided by a special meeting of BMA representatives on 15 March.