Viewpoint: Is Hunt's attack on general practice preparing the ground for a new GP contract?

Behind the caring words of health secretary Jeremy Hunt to improve the NHS, and now his concerns about elderly care, there is a fundamental dishonesty.

Dr Chand: 'Is he preparing the ground for imposing a new GP contract and diverting attentions from his inefficiencies?'
Dr Chand: 'Is he preparing the ground for imposing a new GP contract and diverting attentions from his inefficiencies?'

Since he has taken over there has been a continuous assault on the NHS and on primary care in particular. Mr Hunt’s attack on the 2004 GP contract is politically motivated and economical with truth when he says that it has become more difficult to see a GP, easier to go to A&E, and undermined the personal link with patients.

Is he preparing the ground for imposing a new GP contract and diverting attentions from his inefficiencies?

RCGP chairwoman Professor Clare Gerada is absolutely right when she says, Mr Hunt’s comments were 'disheartening and morale-sapping', for GPs 'battling against the odds - with ever dwindling resources - to provide the best possible care to their older patients'.

It is universally accepted that the NHS is one of the cheapest and most effective healthcare systems in the developed world, with general practice at its heart.

GPs are the most cost-effective part of England's NHS with 9% of the budget and 90% of the contacts. Healthcare is fast shifting from secondary to primary care and funding is not following patients into primary care.

Despite this now Monitor is investigating how strong the ‘market’ is in general practice. I wonder why Mr Hunt/NHS England is so keen to pay Monitor to undertake this enquiry? Why is its priority to expose the supposed lack of competition in primary care? There is very little evidence anywhere that market forces, bluntly used, that is, consumer choice among an array of products with competitors fighting it out, leads to the healthcare system you want and need. In the US, competition has become toxic; it is a major reason for its duplicative, supply-driven, fragmented care system.

Is there a sinister plan to radically change the GP contract? One wonders why they want to replace it rather than work on the few weaker areas to improve them. The NHS and the people it serves can ill afford another decade of instability, misunderstanding and suspicion between the professions, on the one hand, and the managers and public servants, on the other hand.

Mr Hunt should be told in no uncertain terms that primary care is cheap, efficient and safe. The continuity of care has become more difficult because of insufficient resources in general practice. If you want more, pay for it.

It is worth reminding him of the wise words of Professor Don Berwick a world authority on patient safety: ‘The only sentiment that exceeds my admiration for the NHS is my hope for the NHS. I hope that you will never, never give up on what you have begun. I hope that you realise and reaffirm how badly you need, how badly the world needs, an example at scale of a health system that is universal, accessible, excellent, and free at the point of care – a health system that is, at its core, like the world we wish we had: generous, hopeful, confident, joyous, and just.’

What we need is stability in the NHS in general and primary care in particular, which would help change become easier and faster, as the good, smart, committed people of the NHS – the one million wonderful people who can carry healthcare into the future – find the confidence to try improvements without fearing the next unnecessary unwanted change/disorganisation of the NHS.

* Dr Chand is the BMA's deputy chairman but is writing in a personal capacity.

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