We did warn people that the NHS was too important to be left to the doctors. Now with the publication of the Royal College of General Practitioners’ memorandum of advice (aka demands) to the Prime Minister about what must be changed (or else?) in the Health and Social Care Bill, we see more of their true colours. And it isn’t a pretty sight from the standpoint of patient and public involvement – because it isn’t even mentioned! The patient and public voice has been gagged by the doctors.
It’s all about power and not sharing it
It all seemed to start well. Back in November 2010, Clare Gerada then newly installed as Chair of the RCGP said in Pulse, the GP tabloid: “If there’s one thing I’d recommend for consortia and practices to do, it is to set up patient participation groups, because we absolutely have to get patients and the public on side. Patients have got to understand what’s going on.” We supported that. But the very next month she made clear at the Kings Fund in December that she did not mean patients should be seen as consumers, much less as customers. This reflects yet again the visceral dislike (fear perhaps?) that most clinicians have for seeing the users of health services as the consumers they really are. Refusing to see patients as customers is one of the most resistant blockages to any real reform in health care. It stems from an abuse of professional power and a fear of relinquishing it to the people who as citizens are actually paying for the service.
The RCGP’s 27-page advice to Mr Cameron does have some interesting and useful content, no doubt about that. There is a particularly interesting discussion around p 10 of the perverse and unintended effects in the Netherlands of competition law working against establishing clinical networks and pathways and inhibiting partnership working across sectors. We don’t think Mr Lansley ever intended that for his Bill, but the argument is pretty damning nonetheless. It can be fixed with some judicious wording not by throwing the whole thing overboard.
The RCGP is also saying that the NHS must be the “preferred provider”. We remain very wary of the NHS as “preferred provider” because of what that can lead to – no choice, no incentive for improvement in clinical standards, few sanctions and, at worst, take it or leave it inefficient, non-responsive and expensive services. Monopolies lead to the worst of all worlds. We really must do better than that in our most important public service .
Our Ten Point Plan challenge to the RCGP
MAC has already published our 10 Point Plan for the NHS Future Forum laying out what should be changed in the Bill to rectify the main problems with accountability and engagement. We will send this to Dr Gerada with a polite request for the RCGP’s views and publish their response here.
The RCGP demonstrates their aversion to choice and empowered patients in the opposition to abolition of practice boundaries. This has the effect of protecting poorly performing practices and makes it harder for patients to switch to somewhere better or more convenient.
Para 40 is as close as the document gets to pinning down accountability of the consortia, and they fudge that: “….the commissioning function should be essentially a public responsibility that cannot be devolved or fully outsourced, and that consortia must remain publicly accountable for all commissioning decisions and resources, and information about commissioning and provision must be in the public domain and minutes and agendas published with strict rules over conflicts of interest – commissioning is about allocating public funds and there must be appropriate public accountability.” We suppose they mean it can all be left to a few local councillors keeping an eye on things. We do not know what they mean, because they do not say. Certainly there is nothing here about Health Watch – not mentioned – or independent lay scrutiny. That omission “speaks” volumes.
Laity left out by design
However much they may rail against the Government’s plans in the Bill, at bottom it is all a conspiracy against the laity (as Shaw said in The Doctor’s Dilemma). The RCGP document says nothing about lay people’s right to be involved in the decision making process and governance at every level of the NHS. Indeed, the word “lay” doesn’t even appear in the document. Who do they think the NHS belongs to?
This is essentially a reactionary document serving the interests of a particular professional power group. Should we have expected anything more?
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations. We are ready to work with and support all those who want to make sense and a success of the new structures of patient and public engagement within the new arrangements for health and social care commissioning and providing. Feel free to contact us to discuss the opportunities.