Dr Deborah Colvin interview: Taking on the Health Act

GPs can help each other fight privatisation of the NHS, City and Hackney LMC's Dr Deborah Colvin tells Marina Soteriou.

'Competition regulations are going to destroy the NHS,' warns City and Hackney LMC chairwoman and GPC member Dr Deborah Colvin. 'There is no doubt about that.'

Despite her stark warning, the east London GP is one of the success stories salvaged from the DH's competition drive.

A social enterprise chaired by Dr Colvin began to deliver out-of-hours care across the City and Hackney area this month, after winning a battle to take back control of the service from a private provider.

It has not been easy, she admits.

But sitting in her busy Hackney practice in one of England's most deprived, densely populated areas, Dr Colvin says she did not sign up for an easy life.

'If you choose to work in a deprived area, there has to be something that makes you do that in the first place. It is very hard work and you have to have a passion. Maybe it is that that has made people fight harder for the NHS.

'I think people in east London do really believe in the NHS,' she says.

Out-of-hours victory

Dr Colvin's City and Hackney Urgent Healthcare Social Enterprise (CHUHSE) won a high-profile battle for local out-of-hours care in the autumn.

Hackney GPs confronted health secretary Jeremy Hunt at a public event after an initial bid for the service was rejected in March and previous provider Harmoni's contract was extended for six months.

But a second bid from CHUHSE was successful - it will now run the local out-of-hours service on a £6.4m annual budget, a substantial increase on the previous deal. Dr Colvin is confident that it will succeed. 'There are extremely good GPs running it and a fantastic management team,' she says.

But bidding against private competitors was a huge challenge. 'The problem for us was, it was an enormous amount of work and it cost an enormous amount of money,' she says. 'We had some truly exceptional people prepared to work for nothing, gambling because they were committed to it.'

Many GPs would like to form co-ops or social enterprises to run out-of-hours care, but are put off by the paperwork, she adds. Dr Colvin argues that GP collectives should be the preferred provider for out-of-hours primary care.

'The money goes to the doctors who are doing the work. It is not going to private shareholders, therefore you can keep the quality up.

'It is what people want. People want quality. You can't go on getting better and better quality for less and less money.'

GPs should contact existing GP out-of-hours providers and use their bids as templates, she says. 'We need to support each other to do this. You don't have to rewrite the whole thing every single time.'

As an LMC chairwoman for more than a decade, Dr Colvin has become a familiar face in GP politics.

But she only became a member of the GPC last year, as a representative of the Medical Practitioners' Union (MPU), which she joined in protest at the medical profession's failure to block the Health and Social Care Act.

Opposing reforms

'I'm really heartbroken the medical profession didn't do anything about it,' she says, hastening to add that the RCGP was an exception and praising its opposition to the reforms.

She is critical of the BMA, arguing that the MPU - which opposes private firms delivering NHS care - believes in 'a properly funded NHS' and provides 'a vision that the BMA doesn't seem to offer'.

Next year's negotiated contract deal offers a reprieve for general practice, Dr Colvin says.

'But it doesn't really address the core problems facing us, which involve ever-increasing demand for primary care.

'It doesn't put any extra money on the table.' Doing more for less money year-on-year doesn't work, she warns.

One part of the deal given little fanfare was the abolition of practice boundaries. Hackney practices were among the intended testing grounds for relaxing boundaries, but refused to take part in DH pilots.

'It is going to fundamentally destabilise the way the NHS works,' Dr Colvin says.

She fears the policy could destabilise rural practices, undermine monitoring of at-risk children and leave the sickest patients without access to a GP.

'Patient choice doesn't mean choice for everybody. It is choice for people who can afford to make it,' she says.

So how can GPs defend the NHS? 'The public are very strong allies. We need to work with them to get politicians to see this isn't working.

'More and more money will go into competition regulations and not into doing what is right by the patients,' she says.

Dr Colvin admits taking on the reforms has meant personal sacrifices. She half-jokes that she hasn't led a 'normal life' since the Health Act passed into law. 'I haven't had time. You either do what is sane and right for you and walk away, or you behave in this ridiculous way.'

Many GPs and patients will be glad she chose the latter.

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