British attack on family doctors

Doctors’ leaders who oppose the creation of GP “super-surgeries” are echoing their predecessors who likened the establishment of the NHS to Nazi Germany, Alan Johnson says today. The Health Secretary launches an attack on the British Medical Association and the Conservative Party, accusing them of reprising their “infamous double act” when they opposed the health service 60 years ago.

In an interview with The Times Mr Johnson indicated that he is preparing to change funding rules this month to make it harder for single-handed GP practices to survive. He accuses David Cameron of a political gaffe in siding with GPs’ leaders against reforms that, he says, will improve access to doctors, particularly in poorer areas, and allow them to provide better care.

The Government is braced for a battle with both the BMA and the Tories, who say that 1,700 GP surgeries may have to close as a result of the drive to group family doctors into new super-surgeries. The BMA will intensify efforts this week to mobilise patients to oppose the changes with a planned march on Parliament. Critics say that the centres, some of which will be run by companies, may be more expensive, less efficient and force patients to travel farther. But Mr Johnson justifies the reforms, saying that they would reduce health inequalities and increase the ability of the NHS to screen for disease, as well as increase patients’ choice and access while reducing pressure on hospitals.

“This is all additional capacity, it’s additional money, it’s not closing a single GP surgery anywhere in the country. We will not be railroading patients to go to these centres,” he insists. He says there is confusion between polyclinics - health centres designed to bring a wide range of hospital services closer to communities - and GP-led health centres, or super-surgeries. The former were recommended by Lord Darzi of Denham in his review of London healthcare. Mr Johnson said he welcomed a report by the King’s Fund, the health think-tank, that said the polyclinic model should not be imposed in the rest of the country. The imposition of super-surgeries is a direct threat to existing services, particularly single-handed practices, however. And while Mr Johnson insists GPs are still in control he confirms he is preparing to remove a payment - the minimum practice income guarantee (MPIG) - designed to protect GPs operating alone. “MPIG is a barrier to all sorts of things we want to do,” Mr Johnson says.

He accuses his opponents of scare-mongering when they suggest that it could lead to mass closures. “The ludicrous misrepresentation of this policy by the BMA and the Conservative Party is a faint echo of their infamous double act 60 years ago when they opposed the creation of the NHS itself,” he will say in a speech today. Speaking before his address to the IPPR think-tank, Mr Johnson says that he is struck by the similarity of some of the criticisms, particularly the charge that the Attlee Government wanted to make all doctors employees of the state. “There’s a quote from the then leader of the BMA who said: ‘I’ve looked at this very carefully and it reminds me of national socialism as practised in Germany.’”

In an interview with The Times in April Mr Cameron accused the Government of trying to abolish “the family doctor service”. “Communities which have lost their post office, their local shops and their local police station, are now going to lose their doctor,” he said. But Mr Johnson says that the Tory leader has made a “huge political gaffe” in siding with the “producer interest”. “We’ve got world-class primary care but the levels of patients who express concerns about access is large and is growing all the time.”

Laurence Buckman, chairman of the BMA’s GP committee, said that he “did not want to rise” to some of Mr Johnson’s direct criticisms of the BMA, but added: “This Government has thrown away the goodwill and trust of 45,000 doctors, which now they will never get back.” He said that the association was not against phasing out the MPIG in principle, but gave warning that as many as one in ten practices could close if the Government did not provide alternative funding arrangements. “Just over 90 per cent of practices receive some income from the MPIG, and their dependency varies, but without it about 10 per cent of practices will be financially nonviable,” he said. “There’s a fairly even distribution of these, which doesn’t just affect one particular group of doctors or patients, so practices will close in rather arbitrary fashion all over the country.”

Dr Buckman added that it was likely that “a few hundred” small practices would have to close as a result of having to merge into or compete with larger polyclinics or health centres. “No one but the Government has pushed for these reforms, which have puzzled patients and GPs alike,” he added. “It will destabilise the system unnecessarily and seems to be an enormous waste of taxpayers’ money.”

Nick Goodwin, from the King’s Fund think-tank, said: “Primary care trusts must ensure contracts are water-tight and ensure no patient groups or conditions become excluded in the drive for profits. If we are going to bring in private companies, regulation and accreditation needs to be spot on, otherwise they will take us to the cleaners.”

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Australia: More bureaucratic bullying of health workers

Must not blow the whistle on health propblems

A DISPUTE over a memo has cost Queensland taxpayers more than $120,000 in legal fees, and patients the services of a veteran therapist. Senior speech pathologist Quaneta Greenwood, was suspended, with pay, 13 months ago after she wrote a memo exposing a staffing problem that threatened federal funding for a state nursing home. Fraser Coast health district manager Kerry Winsor said the memo portrayed Queensland Health in a bad light, and she banned Ms Greenwood from seeing patients, gagged her from speaking to the media and accused her of misconduct.

As a result, taxpayers are stuck with a growing legal tab and are paying Ms Greenwood not to treat patients. Records show the bill for Queensland Health's lawyers, Minter Ellison, totalled $120,000 by September. Health Minister Stephen Robertson recently denied health workers were still being bullied by health bureaucrats. Yet Supreme Court documents filed by lawyers for Ms Greenwood include bullying and harassment among the claims. A Queensland Health spokeswoman said: "Since this is a matter between the employee and the department, it is inappropriate to comment while the process is ongoing."

The case hinges on a single-page memo, dated April 17, 2007, written by Ms Greenwood and a co-worker to five colleagues about speech pathology services to Yaralla Place nursing home. The memo said the district did not have enough staff to meet extra speech-therapy services requested by federal inspectors who found the home deficient. "To attend to these (referrals) we would be spending much of the day, every day at Yaralla Place, which is simply not possible," Ms Greenwood wrote. "Our department is not resourced to provide such services."

In a memo a month later, Ms Winsor accused Ms Greenwood of suspending nursing-home services without authorisation and demanded she turn in her work keys and stop treating patients. Ms Greenwood, who had spent 23 years treating cancer and stoke victims with speech and swallowing problems, was devastated by the accusations. In a court affidavit, she said she exposed the problems to help the health system and the public. "It is wrongly asserted I withdrew services. In fact I worked over the Easter holidays to provide patient services to those I had objectively assessed as needing a rapid response. I was simply doing my part to try and see to it that accreditation would go ahead. "The Aged Care Accreditation team were threatening sanctions if the dietetics and speech-therapy-patient backlog was not dealt with."

Barrister Stephen Keim, SC, is representing Ms Greenwood, who is seeking to have Ms Winsor stopped from taking further disciplinary action. Mr Keim argued that the bureaucrat could not be impartial in determining misconduct because she had shown bias against Ms Greenwood. But Justice John Byrne dismissed the application, which is being appealed at a further cost to taxpayers

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