GPs condemn CBI in access row

Damning CBI report recommendations add to the debate over the future of the NHS, Joe Lepper reports.

[TX]Last week the Confederation of British Industry (CBI) surprised many GPs by controversially adding its voice to the debate into the future of the NHS, with the release of its report 'Just What the Patient Ordered: better GP services'.

This offered a damning indictment of modern general practice as, 'an outdated and rigid family doctor service' that 'is resulting in less effective and unequal healthcare and is placing an unnecessary burden on employees and businesses'.

A chief concern of the CBI is that in many areas access to services is poor and employees are forced to take extra time off work to travel further to their GP, where they wait longer.

To back this assertion the CBI commissioned a survey of 1,014 patients, which showed that 31 per cent found it difficult to get an appointment at a time convenient to them.

The CBI's vision for reform included ideas that are already being looked into by the government. Greater private sector involvement in the delivery of health services through alternative primary medical services (APMS) contracts was suggested, as was a greater diversity in service provision through schemes including nurse-led services.

Other CBI ideas already being looked at by the government included the introduction of polyclinics.

This was recommended by health minister Lord Ara Darzi, who is carrying out a national review of the NHS, in an earlier review of healthcare in London.

CBI recommendations
Other far-reaching recommendations included dual registration, allowing patients to register near to home and work, and alterations to the quality framework. The latter would mean making targets tougher and the system more ruthless, so practices that fail to meet targets will close or 'exit the market'.

Dr Robert Morley, Birmingham LMC executive secretary and GPC member, is among a number of GPs to question the CBI's recommendations and in particular its motivation for entering the debate on the future of general practice.

He said: 'I think this is less about whether their members' employees can see a GP when they want to and more about whether their members can gain an advantage in the privatisation of health services.'

He also argued against the CBI's survey saying that the primary concern among patients is not access to services but continuity of care.

'What patients really want is the family doctor that they can see not just the once but time and again for 10, 20, 30 years. They are less bothered about getting 24/7 access.'

Dr Harry Yoxall, Somerset LMC secretary, also questioned the validity of the CBI entering the debate. He said: 'I don't tell the CBI how to run British industry so I don't expect it to tell GPs how to do their job.'

He also criticised the CBI's backing of dual registration, saying that the funding system needed would be too complex to implement effectively and that the system would be impossible to run until a 'truly integrated IT system' was in place.

Private sector
Dr Nigel Watson, Wessex LMCs chief executive, believed that instead of discussing the future of general practice, 'if the CBI truly cared about employees and their health needs then it would be urging its members to invest more in occupational health schemes'.

CBI spokesman Matthew Maxwell Scott defended business's record on occupational health saying that larger firms already invest heavily in occupational health schemes and had their own medical staff on site.

But he added: 'This is not practical for every firm and also employers already pay their taxes to fund a health service. Why should they do it again?'

He defended the report's emphasis on alternative and private sector involvement in running health services.

'What this report is not about is putting down GPs and the good work they do. What it is about is discussing ways that health services can improve and we believe that, particularly in under-doctored areas, alternative providers have a lot to offer.'

Dr Peter Jolliffe, Devon LMC chief officer, believed that the CBI, as well as ministers, too often looked at general practice in isolation and their assumptions were out of date.

He added that on issues such as evening and Saturday morning access, 'it is no good having that if the secondary care is also not open at this time'.

Despite GPs' complaints, the CBI and the business world have clout among ministers. The CBI's former director general Digby Jones, now Lord Jones of Birmingham, is close to the government as an adviser on 'skills'.

In addition, as the CBI report was being unveiled it was announced that Pizza Express entrepreneur Luke Johnson was in talks to run a chain of NHS cancer centres.

The CBI's vision already appears to be coming partially true and GPs will be watching closely to see how much further their influence takes them in the running of health services.

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