White Paper on Health 2010

Dear Jo,

I am aware that health matters are entirely devolved to the Scottish parliament, but as a Scottish representative on the national committee of the National Health Service Consultants Association, a UK body, I write to express my concerns about several aspects of the proposals in the White Paper published on 12 July 2010.

The proposal that GPs be given approximately 80% of the NHS budget for direct comissioning is extremely concerning, particularly to those of the profession who subscribe to the concept of the NHS as a publicly provided and funded service.

With 227 (approximately 20% plus) of general practices in England already run by profit-making private health care companies it is likely that these practices will place contracts with the same companies who may well be providing secondary /tertiary healthcare.

The nearest we got to the market in Scotland was the abortive effort of the Thatcherite government to introduce fundholding general practices, which proved a disaster. Relationships built up over many years between general practitioners and hospital consultants deteriorated seriously. There was widespread agreement between both patients and doctors that this was not the best way forward . Scotland,having a more social conscience almost unanimously rejected this policy and the market was eventually abolished.

On a personal note, I can cite a situation where a fundholding practice in Kirkintilloch undertaking haematology investigations for a drug trial, decided to send their samples for analysis to a private laboratory in England which was 50 pence per sample cheaper than my own department in Stobhill Hospital. It provided a “result only” service with no interpretation of the information which was produced mechanically. As a consequence of this economy this laboratory failed to diagnose that an apparently healthy patient had acute myeloblastic leukaemia. This same local practice also had visions on buying an in- house near patient testing machine, and would no longer send us their samples. However, when it was pointed out to this” commissioning” GP that they were legally responsible for the results and the quality control of the equipment, they rapidly backed off.

Commissioning the cheapest service for profit is not the best way forward.
There is a suggestion that management numbers may be reduced centrally. However, doctors are not educated in matters of contract, and it is likely that those displaced centrally, would be employed peripherally in the new consortia.

As far as I can see there is little mention of consultants in the White Paper. Will they still remain as NHS consultants or will they also be subject to the vagaries of the market with widely differing conditions and terms of service which can only fragment the service further? One of the advantages of the national contracts is that the uniformity of terms and conditions, enables the less “ popular” areas to acquire good quality staff.
I enclose a copy of a booklet produced by the “Keep our NHS Public Campaign” which is affiliated to the National Health Service Consultants Association, together with some letters and articles published in last week’s Guardian. When I raised the question of the coalition government’s health service policy with you at a recent meeting you indicated that you would be happy to pass any comments to Paul Burstow, the Liberal Democrat Minister of Health. I ask you to do so.

I look forward to hearing your comments on the points which I have raised.

Yours sincerely,

Chairman, Scottish Health Campaigns Network