Taking time out from knocking on doors for the Labour party's general election campaign, the peer -whose list of roles in the NHS stretches back more than four decades - spoke to GPonline about the party's plans for primary care.
Lord Hunt, the first chief executive of the NHS Confederation in the 1990s and now the Labour party’s deputy leader in the House of Lords, set out Labour’s vision for health services over coffee in Euston, central London, a district packed with venerable healthcare institutions and the birthplace of the NHS.
He acknowledges the Labour manifesto is light compared with Andy Burnham’s detailed plans for health and social care integration in 2015. That is a consequence of the surprise nature of the election, coming midway through the party’s five-year policy development cycle, he explained.
But it is also a new recognition, he says, that government edict is not always the best approach for the NHS. ‘You can't dictate everything from the centre.’
On funding, while the party has outlined a £37bn five-year package of revenue and capital - more than either the Conservatives or Liberal Democrats have promised - and has pledged to increase GP funding, Lord Hunt cannot say how much primary care will get or even whether existing promises in the GP Forward View would be matched.
For a Labour government, working with GPs to properly understand what the service needs will be as important as the money, says Lord Hunt. ‘I think the first thing we need to do as ministers is to show how much we value the profession and what they do,’ he says. ‘That would be my prime aim.'
While current NHS plans acknowledge the importance of general practice, the peer says the government had ‘done its best to demoralise and, almost do anything it could to tell GPs: "You're not valued",' with rising workload, increasing demands for expanded access and growing bureaucracy. ‘No wonder the profession is feeling a bit beleaguered,' he says.
Labour ministers would seek to engage the profession to draw up spending plans for new investment in GP and practice workforce retention and recruitment. The party, however, will not commit to meeting the existing target for 5,000 new GPs by 2020, instead focusing on a new longer-term workforce plan for the next decade and beyond.
Funding would also support new continuing professional development for GPs and ministers would look again the changing role of primary care and how that should be funded.
Labour would re-examine the ‘fantasy’ of the Five Year Forward View’s plans for integration which Lord Hunt says ‘holds out a vista of stronger primary health with not much in the way of dosh’. However, he says, Labour would not seek to impose new top-down reorganisation in its ambition for a new model of integrated out-of-hospital care.
Where existing integration programmes, such as MCPs, are working ‘we should rejoice and spread the message’, he says. And where GPs are able to initiate and lead collaboration and integration from below, Lord Hunt would ‘welcome them with open arms’.
Despite manifesto commitments to tear up former health secretary Andrew Lansley's reforms under the Health and Social Care Act 2012, the former foundation trust chair and hospital administrator is at pains to stress Labour does not want another reorganisation. The focus of repealing the act would be on sections compelling commissioners to put NHS services out to tender, with the introduction of a preferred provider status for the NHS, which he says would reduce costs and free local clinical leaders to focus on better service design rather than contract management.
GPs, says Lord Hunt, can do a lot towards better integration, but ‘grandiose schemes that think with a magic wand you can integrate the whole health and social care, are often naive’, he says. ‘I'd much rather put my money on small schemes that break the barriers, share information.’
While further consolidation of practices is inevitable as the CQC regime weeds out the worst, Lord Hunt says, he does not share the current regime’s desire for larger-scale provision. ‘My own view of the overall organisation of GP services is it is really better to let a thousand flowers bloom.'
GPs are revolutionising primary care provision in response to pressures on the NHS, he says, with new forms such as super practices, federations and greater private sector involvement. ‘I think it's best to let that roll out, rather than ministers making edicts which may not fit local circumstances.’
Traditional general practice
The shadow minister cites the Vitality super-partnership in his home city of Birmingham, as a model that creates leadership while maintaining traditional GP partners. ‘Sometimes,' he says, ‘encouragement from the top may be the best way to encourage change and modernisation. When clearly the profession itself is leading the development of new models, I think it's best to encourage them to continue to do that.’
Labour would introduce a new Health and Social Care Bill and give responsibility for the NHS in England back to the health secretary. Labour wants more accountability in the system, and would halt and review sustainability and transformation (STP) plans. While the party has ‘no problem’ with the principle of local partnership across NHS and social care organisations, Lord Hunt says, STP plans to transform services have been developed on the basis of financial balance, creating plans which ‘everyone knows’ are ‘complete fantasies’.
‘It's the usual health service curse of double counting the money. Because in order to get financial balance and invest in the kind of services that you need to invest in - where is the money to come from? So often they've pulled out fantasy figures about how they can reduce the acute care footprints, which we just know is not realistic,' he says.
‘Ministers will simply want to review each one and make sure that they're heading in the right direction. And of course the last thing we want to do is inhibit partnership working and helping to keep primary care an enhanced role in the future. It's not unreasonable for a new government which wants, in any case, to eyeball NHS England about whether the Five Year Forward View and the STP programme is sustainable.’
Lord Hunt says he is particularly interested in establishing work he initiated previously as a health minister under Gordon Brown to reduce bureaucratic burdens on GPs. ‘I would say to the profession, come into the department, let's look at all the bureaucratic demands that are being made upon you, let's get a troubleshooter in, someone who can be tough and eyeball all the organisations asking for it, and let's set up a program for trying to reduce it.’
That could include reducing the burden of target payment mechanisms such as the QOF, he adds. ‘If you were serious about wanting to re-engage the profession in a way that we really want to do, it's partly looking at rewards and sanctions. But it is also looking at just trying to make things easier for them.
‘If you try and put a price on everything, you know some of the value that they give because they go beyond the mile, which most GPs do. You lose some of that.’
But Labour would not support any move towards co-payments Lord Hunt says, just days after the BMA’s annual conference of LMCs voted for GPC to produce a discussion paper on alternative funding systems.
‘We wouldn't be very keen on that at all. It is a really important principle, we believe, of the NHS being funded mainly out of taxation.’ But, he adds, practically it would create more burdens on practices and, like prescription charges, those who use most would likely be exempt anyway.
‘Really,' he adds of the LMCs vote, ‘it was a cry from the heart. I take it that this is really about the desperation about funding. I think our job is to say look, we're not going down that route. What we are going to do is sort out the funding long term for the health services.’