On 10 November, general practitioners (GPs) from across England attending the first local medical committees (LMCs) conference voted against a motion calling for the British Medical Association (BMA) to support doctors who wanted to “operate within a private, alternative model” in response to the increasing strain and pressure being borne by local surgeries.
Bedfordshire LMC’s Christiane Harris, proposing the motion, had an interesting approach to the way she illustrated the views of the colleagues she represented. Quoting health secretary Jeremy Hunt’s statement that many general practitioners feel like they are “on a hamster wheel” regarding the huge workload and extended hours presently required of hard-pressed doctors, she presented a case, via a metaphorical comparison to the construction industry, that being expected to complete a job in a shorter period of time than is necessary, at a lower cost, and using inferior materials, would be unthinkable in any profession other than that of a GP.
We may confidently assume that Dr Harris does not have any particular experience in the building trade, but for anyone that does, such an expectation on contractors and their subcontractors would come as no surprise; it is in fact, par for the course.
Under the conditions of crisis-ridden capitalism, under which all businesses operate today, the practice of cutting corners anywhere one can, and passing the buck through complicated manoeuvres so as to ensure you’re not the one left holding the can when some aspect of the construction later fails, is not anywhere near as unusual as the proposer of this motion evidently wanted her audience to believe.
As was to be expected, the motion aroused great passions amongst those attending the conference, and the speakers taking the podium ranged from those bitterly opposed to any further carving into the NHS carcass to silver-tongued practitioners who’ve clearly been greasing the wheels of the privatisation process for decades.
A telling sign of how under fire some doctors feel – not just from the government and the privatisation process it’s so keen to complete, but from the bourgeois media, with its tactic of presenting the NHS as completely unfit for purpose until a ‘new way’ of running it is established – is the what appeared to be the decisive argument against the motion, alluded to by several of the people on the platform, including the deputy chair of the GP committee.
The argument went something like this: that the message sent out by passing such a motion would create a field day for the media to tear the profession apart, and thus would do so much harm to the prestige of doctors in the eyes of the general public that it would be against the interests of the profession and the body representing it to vote in favour.
Annie Farrell, representing Liverpool LMC, posed the issue thus: “Sending a signal that GPs in England are happy to promote widening health inequalities is dangerous … What may be an option for people in Bedfordshire certainly isn’t an option for our patients in Liverpool.”
Dr Farrell, in treating the issue as something that may have far less support among patients in some areas than in others, correctly identified the topic as predominantly a class issue. No one would try to claim that doctors in Liverpool are under less stress and have smaller workloads than doctors in Bedfordshire, but it would be foolish to claim that patients everywhere in the country have the same financial ability to seek private healthcare.
The contradiction within the argument for the BMA to support any practice seeking to offer private healthcare, whether instead of or alongside NHS services, was illuminated by Bedfordshire LMC’s Dr Harris as she asked the delegates to “debate what the motion says rather than what it has been interpreted as saying”.
Clearly, the idea of allowing GP surgeries to make up their funding shortfall by offering and charging for “things which are not NHS services anyway” (ie, expensive procedures not related to actual physical health) cannot in any way be squared with the argument that such a move would reduce the workloads of the practitioners – or, of course, the waiting lists of citizens urgently requiring the attention of an NHS doctor.
It would, however, encourage doctors to take more private work than many of them already do, and while this would undoubtedly be good for their individual savings accounts, there is simply no argument for saying it would result in the delivery of a more efficient healthcare system for the majority of NHS patients.
Only a fool could fail to see that encouragement for healthcare professionals to move even further into the sphere of private practice would not do anything other than accentuate the already deeply troubling crisis that the NHS faces following years of the gradual undermining of the principles on which it was supposed to have been founded.
The breaking up of the national body into regional trusts answerable to individual business managers, the asset stripping of land and buildings formerly under national jurisdiction, and the ridiculous levels of debt incurred by Labour’s disastrous Private Finance Initiative (PFI) scam have all served to bring the institution to this point, and we only have to look to other areas of social provision that have been fully opened up to the tender mercies of private practice, such as social care, to see how much worse the situation could get.
While the conference’s rejection of the proposal is obviously to be welcomed, the uncomfortable truth is that any GP fighting to keep services free at the point of use at this stage would be in a much stronger position had the BMA been steadfast in opposing all forms of NHS privatisation since the outset.
The regionalisation of GP services and the introduction of a spurious internal market for allocation of services and provisions have burdened GPs with such massive administrative paperwork leading to such an excess of working hours that many are simply being driven out of business. The Times of 22 November 2017 reported: “NHS Digital figures show that there were 41,324 GPs working for the health service in England at the end of September, 240 fewer than in June and 541 fewer than September 2016.” (Fewer GPs despite pledge to hire 5,000 by Chris Smyth)
Unless the privatisation preparatory measures that have been implemented by Labour and Tory governments over the last three decades are reversed, it is only a matter of time before NHS GP provision dwindles to the point of virtual non-existence.
With all this in mind, it is more apparent that the stance of the BMA on this issue constitutes an ‘11th-hour’ paroxysm of guilt as the realisation sinks in that a step such as supporting GP surgeries’ move to lucrative but socially damaging private practice would surely be understood as the final death-rattle of the NHS in the eyes of British workers.