Dr Sarah Wollaston Interview: A different kind of politician

Dr Sarah Wollaston belongs to a new breed of politician, aiming to take the tribalism out of politics. Neil Roberts reports.

Dr Wollaston: 'Where general practice is working well, if it ain't broke, let's not fix it.'

GP turned MP Dr Sarah Wollaston was elected to chair the influential House of Commons health select committee last summer, after the resignation of Stephen Dorrell.

We meet in the House of Commons smoking room, which resembles a plush gentlemen's club. As the Conservative MP for Totnes, Devon, points out, times have changed - smoking is no longer allowed here.

Dr Wollaston is a consciously modern politician. In the previous parliament, she would never have become a health committee member, let alone its chairwoman, she says.

She owes her rise to a change of rules in 2010, giving MPs rather than party officials power over select committee membership. In the past, members were 'the kind of person who agreed with everything the government said'. Now, more have an interest or expertise in the area.

Scrutinising role

'I'm not a tribal politician,' says Dr Wollaston. She came into the Commons to scrutinise, not climb the ladder of government. So, she says, chairing the health committee is 'the best job for me'. It is about 'leaving party politics at the door and trying to do a job on behalf of the public'.

In 2009, Dr Wollaston stood in the Tories' first 'open primary' to select a parliamentary candidate. Her campaign highlighted her real-world experience and lack of professional political background.

She wasted no time proving her non-tribal credentials, warning that former health secretary Andrew Lansley's reforms could 'destroy the NHS'. She later voted for the Health and Social Care Act, after changes on competition and integration.

Today she maintains that while some of the reforms were necessary, clinical commissioning could have been achieved through PCTs. But as a back-bench MP, she learned that 'your power to actually stop something is nil'.

What about future Tory health policy? Dr Wollaston is not convinced by a £100m extension to the Challenge Fund, or plans for 8am to 8pm and weekend GP access across England by 2020.

While better access is desirable, she thinks the policy is unachievable, given the current GP workforce crisis. That level of access is 'almost impossible' in rural areas, she believes.

GP workforce

The government, she suggests, is doing what it can to boost the GP workforce, with its requirement that half of doctors leaving medical school choose general practice.

The problem is, they don't want to. For that, the former GP trainer and examiner partly blames medical schools. 'Generalism is hugely undervalued at medical school,' she says.

After starting her own career in paediatrics, she switched to general practice when 100-hour weeks became unsustainable. 'It was the best decision I've made,' she says.

More doctors should be enabled to switch by allowing a stand-alone training year in general practice, she says. 'We are risking losing people who can't get a consultant post, or who, like me, decide as they are going through a particular specialty training, it's not for them and they want to do general practice.

'We are risking people like that making a choice to go to work abroad instead.'

Some GPs struggling under heavy workload should use some of their profits to fund more staff, she believes. 'We all know there is a workforce shortfall and many practices are trying to recruit more staff, but there are also GPs working under pressure who perhaps should be employing another practice nurse.'

There is an argument for a profit cap on practices, she argues. 'If we are going to introduce an obligation for private companies to limit the profit they take from the NHS, should we apply the same to general practice?'

While recognising the 'crisis', Dr Wollaston says people should be careful not to talk it up too much. She rejects RCGP chairwoman Dr Maureen Baker's view that general practice is 'under threat of extinction'.

But she fears for the service under a future Labour government. 'If Andy Burnham got rid of independent contractor status, I think that would be a very major threat.'

Labour's shadow health secretary has said he would not abolish the model, but would ask NHS trusts to form integrated care organisations that could employ salaried GPs. Or, as Dr Wollaston sees it, 'nationalise general practice'. 'I think that would be catastrophic,' she says.

The plans could work in areas with recruitment problems, she says, but 'where general practice is working well, if it ain't broke, let's not fix it'.

Politicians, she adds, have a tendency to want to rearrange. Labour's plans, she says, 'fill me with horror'.

One of her frustrations as an MP is the sense that more people working in the NHS should influence policy. She wants more GPs involved in select committee inquiries. She uses Twitter and other media to 'crowdsource' views before hearings.

NHS spending

Last week the committee began hearing evidence on NHS expenditure. This is 'crunch year' for the NHS, she says, 'when the cracks really start to show' from 4% year-on-year efficiency savings.

The inquiry will measure the funding gap and challenge all parties ahead of the election to acknowledge and address it.

Solutions might include tax rises, top-up payments or charging. 'The point is, those options need to be set out, and I don't think political parties should duck the issue.'

On the way out through labyrinthine corridors, Dr Wollaston comments on what a strange place parliament is to work in. But she still wants more GPs to join her. 'Otherwise we'll always have people who have never worked in the NHS running it.'

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