GPs must act to save NHS, says leading academic

Interview Allyson Pollock tells Colin Cooper GMS is not working.

Professor Allyson Pollock is a passionate critic of the 'toxic mix of ineptness and greed' that she believes has led the Labour government to the brink of dismantling the NHS.

The head of the Centre for International Public Health Policy at the University of Edinburgh is not one to pull punches.

First of all, the DoH's view that GP practices have always been small, private businesses is quickly dismissed.

The previous GMS contract gave GPs independence, she says, but it was a public contract between an individual GP and the health secretary, not a commercial contract. Staff and premises commitments were underwritten by the state.

'Although some GPs may have behaved like businesses, they were not exposed to market forces. So it's totally misleading for the government to describe them as small businesses, but very convenient given its current policies.'

She obviously has a fondness for the 'transparency' of the Red Book. But this doesn't extend to the new GMS contract, which she says GPs should campaign to repeal.

'This GMS contract has allowed the commodification of care, the entry of alternative providers. It allows the deregulation of care - the market does not like to have any barriers, for example staff terms and conditions or professional norms of service.'

The Healthcare Commission's recent report on out-of-hours care reveals the pitfalls of letting the market run NHS services, says Professor Pollock.

She is particularly concerned that the DoH is not gathering data about commercial providers' activity, despite the work being funded by the NHS.

'At a time when we have unprecedented market failure in the financial sector, we have a government committed to following the same policies in healthcare.

'Hospitals are closing and deficits are rising. Is the government going to bail out those trusts that lose in the market? This is no way to provide healthcare. It's a travesty.'

Professor Pollock sees general practice as an important piece of the 'deregulation jigsaw', having been the bedrock of the NHS for 60 years.

'GPs have been preoccupied with their own terms and conditions, instead of taking control of the system and making it work well for their patients.

'If it works well for their patients, it will work well for them.' And she is unimpressed by attempts to organise GPs to compete with large private providers.

'The idea that GPs can play businessmen is a fallacy. They will end up being employed by large American corporations.'

And Professor Pollock sees little cause for optimism in the current climate. 'It's a very bad time for general practice, the lowest point in its history.

'The BMA leadership has repeatedly betrayed its grassroots members and the fundamental principles of the NHS. They are looking after a very small subsection of vested interests.' Most doctors are 'not entrepreneurs', she adds.

Professor Pollock wants the BMA to try, as in her native Scotland, to remove laws allowing commercialisation in the NHS, and says GPs should take back 24-hour responsibility.

'When GPs gave up out-of-hours they were giving up on patients for two-thirds of their lives.' GPs are heading 'the way of NHS dentistry', she warns.

It is this inequity, and the potentially 'catastrophic' effect on public health this could create' that is her greatest concern.

'We do not hear the complete misery of people, older people stuck at home, who are not getting the care that they need. Those are the stories that do not make it into the media.'

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