Dr Paul Williams’ specious Comment is Free piece in the Guardian on 8th May 2019 uses buzzwords like ‘nationalisation’ of GP services. But when you look at what he means by this, it turns out to be “employee-led mutuals” – as advocated by Norman Lamb and the LibDems.
The arguments against NHS employee-led mutuals were clearly laid out by Caroline Molloy back in 2014 . The main one being that we the public already own the NHS and splitting it into mutuals would effectively end public ownership.
Regardless, this proposal keeps resurfacing as part of the neoliberal “cross party consensus” that Sarah Wollaston MP, chair of the House of Commons Health and Social Care Select Committee, is so successfully advancing. As a member of the Select Committee and a doctorpreneur himself, Dr Paul Williams is an enthusiastic advocate of that position.
There are dots to connect between the Select Committee’s inquiries into STPs, ACOs and now the NHS Long Term Plan; NHS England’s proposed primary legislation for the Long Term Plan; and Dr Paul Williams’ opinion piece.
NHS England’s proposed Long Term Plan primary legislation – strongly supported by the Health and Social Care Select Committee – includes the creation of new NHS Integrated Care Provider Trusts. And in February, the government passed secondary legislation to allow GPs to suspend their General Medical Services/Alternative Provider of Medical Services/Personal Medical Services contracts in order to become employees of Integrated Care Providers. This was unsuccessfully opposed by a Prayer Motion.
When you connect these dots, it’s clear that what Dr Paul Williams is advocating is not nationalisation of GPs as I would understand it – which would mean passing the NHS Reinstatement Bill.
Instead he is covertly rallying support for both the government’s NHS Long Term Plan to dismantle the NHS into a series of Integrated Care Systems and Providers, based on the USA’s Accountable Care Organisations system, and cheerleading for the enabling primary legislation that’s designed to bring into being new NHS Integrated Care Provider Trusts, set up as mutuals and directly employing GPs.
His stealth advocacy of Integrated/Accountable Care is bolstered by the tendentious claim that because pursuit of profit is their overriding motive, GP Partnerships, operating as independent contractors to the NHS, refuse to deliver services like health checks that would ostensibly benefit their patients.
But when you read GPs’ accounts of why they are refusing to carry out some of the tasks that the government is asking them to take on, you will find it is generally because they are exhausted and overwhelmed as a result of having to do the work of the many other public services that have been closed down because of public spending cuts.
And because they have good reason to doubt the value for patients of the tasks they are being asked to carry out – GP Margaret McCartney (author of The State of Medicine) is rather scathing about the uselessness and even active harm of many health screening tests.
Dr Paul Williams makes no mention of nine years of underfunding for GPs, which is the root cause of the problems he identifies. Or of the cuts and closure of many public services that the public rely on, which both worsened people’s health and has driven increasing numbers of patients to turn to their GPs as the only remaining source of help.
And then there is his support for Primary Care Networks. From where I’m standing Primary Care Networks – which NHS England says are key components of cost-cutting Integrated Care Systems – look like a recipe for restricting patients’ access to health and social care, plus something very like the Thatcherite proposals for a voucher system, via increased use of personal health budgets, and a whole train of other undesirable consequences. As outlined here.
I am about to go and stand in the rain at Hebden Bridge market urging people to sign a letter to their GPs asking them NOT to register for a Primary Care Network contract.