How would a Tory DoH suit GPs?

Many GPs will vote Conservative, but are not sold on the party's health plans. Jonn Elledge reports.

By summer next year, it seems likely, Andrew Lansley will occupy the big desk in Richmond House.

Many GPs will greet his arrival with a sigh of relief. Relations with the current government have been so soured by the battles over polyclinics and extended hours that, as a recent GP poll confirmed, more than half the profession are now backing the Tories (GP, 9 January).

This, perhaps, is not surprising. As small businessmen, many GPs are a natural Conservative constituency (this, at least, is health minister Ben Bradshaw's excuse) and the shadow health secretary has spent the last couple of years going out of his way to court the GP vote.

He has promised them more respect and less interference. He has slammed Lord Darzi for 'recklessly tearing down' local services to solve an access problem that does not exist.

A Conservative government, he says, would 'put power and responsibility back in the hands of GPs'.

Private sector fears
For all his sweet words, though, it is not entirely clear Mr Lansley would get much of a honeymoon as health secretary.

At the BMA's recent political debates it was he who faced the greatest hostility. GPs still are not convinced by many of the Conservatives' plans.

Perhaps the biggest split between party and profession concerns the role of the private sector. The government's enthusiasm for APMS and Darzi centres has led many to conclude that its goal is a full privatisation of the health service.

Nonetheless, there are reasons to think Labour might be more in tune with GPs than its opponents on this issue. Health secretary Alan Johnson has always said he expects most new health centres to be run by GPs.

Also, during a recent round table debate organised by the New Statesman, only public health minister Dawn Primarolo favoured any limit on private provision.

For Labour, competition remains a way of putting pressure on practices, not an end in itself, it would seem.

Mr Lansley, in contrast, says he is all for opening the NHS to 'any willing provider'. Any GP who thinks the horrors of APMS contracts will go away with a change of government, will, in the words of a CBI spokesman, 'get the shock of their lives'.

Conservative plans to devolve commissioning budgets to practices have also raised eyebrows. Some GPs adore the idea, which would free them from PCTs and cement their role as a patient's first contact with the NHS.

Real budgets 'are the only way to get PBC moving', argues National Association of Primary Care president Dr James Kingsland.

Unrealistic plans?
But others are less convinced. Partly this is down to unpleasant memories of fundholding. But partly it is because of fears the plans might not work.

'The small size of practices means you get some very bizarre mixtures of referrals,' says GPC member Dr John Canning. A string of referrals to, for example, psychiatric services in one year may be followed by nothing the next, he says. 'You need a very large population to share the risk properly.'

A new government could also find itself clashing with the profession on other issues.

Rural GPs fret that plans to make them responsible for commissioning out-of-hours care will mean the return of the 3am call-out.

Dr Ron Singer, Medical Practitioners' Union president, says plans to link the QOF to patient-reported outcomes gloss over the fact that health interventions can take years to have an effect.

Dr Kingsland admits he is baffled by Mr Lansley's objections to integrated care organisations. 'If I, as a GP, can't be both commissioner and provider,' he says, 'then I can't refer patients.'

Perhaps the biggest question hanging over Conservative health policy, however, is if it will ever be implemented. Another shadow health secretary once promised to listen to GPs, cut bureaucracy and make their hours more family friendly.

That was in 1996; Harriet Harman never became health secretary, and 10 years later those promises look pretty hollow.

'Anything a politician says has to be taken with a pinch of salt,' says Dr Singer. 'Particularly in opposition.'

What GPs think

"GPs will support any party that says it will empower them to take ownership of service and take out targets that direct their day-to-day management of patients. But that's what we're hearing from both Labour and the Tories at the moment."
Dr James Kingsland, president, NAPC

"All parties are committed to the NHS - but as a funder, not provider, of services. A change of government will give us a chance to fight against the culture of short-term, quick fixes. But I'm not convinced there'll be a change of philosophy."
Dr John Canning, secretary, Cleveland LMC and GPC member

"Some GPs have short memories. It was the previous Tory government that created fundholding and began the moves from a publicly to privately funded health service. The Tories will push privatisation even faster than Labour has."
Dr Ron Singer, president, MPU

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