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Jeremy Hunt's blundering blaming of GPs makes for bad politics Jeremy Hunt's blundering blaming of GPs makes for bad politics
(4 months later)
The inevitable NHS crisis has begun to rumble even sooner than predicted. Not two months into the great commercialising upheaval, and blood pressure in the NHS is already rising. When a spending tourniquet squeezes both health and social care, A&E always shows the first symptoms. Jeremy Hunt, the health secretary, has some gall in blaming GPs, when the entire NHS plan was designed with the pretence of putting the service into the friendly hands of your trusted family doctor. In the government's lexicon of blame, GPs have gone from hero to zero in no time. Yesterday's BMA conference made plain they won't stand for it.The inevitable NHS crisis has begun to rumble even sooner than predicted. Not two months into the great commercialising upheaval, and blood pressure in the NHS is already rising. When a spending tourniquet squeezes both health and social care, A&E always shows the first symptoms. Jeremy Hunt, the health secretary, has some gall in blaming GPs, when the entire NHS plan was designed with the pretence of putting the service into the friendly hands of your trusted family doctor. In the government's lexicon of blame, GPs have gone from hero to zero in no time. Yesterday's BMA conference made plain they won't stand for it.
Money is the immediate cause: the NHS falls over if denied a 2% real increase. Everyone – from Stephen Dorrell, head of the health select committee, to just about every health economist – warned David Cameron. Margaret Thatcher caused eruptions by cutting too hard, as did Tony Blair by spending too little in his frozen first two years – but neither tried such a squeeze as this alongside a tumultuous £3bn re-disorganisation.Money is the immediate cause: the NHS falls over if denied a 2% real increase. Everyone – from Stephen Dorrell, head of the health select committee, to just about every health economist – warned David Cameron. Margaret Thatcher caused eruptions by cutting too hard, as did Tony Blair by spending too little in his frozen first two years – but neither tried such a squeeze as this alongside a tumultuous £3bn re-disorganisation.
Blaming Labour's GP contract of a decade ago is an absurdity contested even by those who solidly support the government's plan, such as the NHS Confederation. Alan Milburn, as Labour health secretary, did have the wool pulled over his eyes on the 2004 GP contract, and the BMA struck gold – winning pay for lucrative targets too easy to hit while letting GPs buy off out-of-hours duties too cheaply.Blaming Labour's GP contract of a decade ago is an absurdity contested even by those who solidly support the government's plan, such as the NHS Confederation. Alan Milburn, as Labour health secretary, did have the wool pulled over his eyes on the 2004 GP contract, and the BMA struck gold – winning pay for lucrative targets too easy to hit while letting GPs buy off out-of-hours duties too cheaply.
But escape from unsocial hours did solve the acute shortage of GP trainees. Contrary to Hunt's claim, A&E visits didn't soar after the GP contract, only increasing by the 1% or 2% expected with an ageing population, according to the government's own Emergency Care Review. Lest Hunt forgets, Labour left the NHS with virtually no waiting lists for operations or long A&E waits, and patient satisfaction at the highest ever recorded. Hunt's attempt to blame the GP contract is, even by his standards, an eye-watering, breathtaking economy with the truth.But escape from unsocial hours did solve the acute shortage of GP trainees. Contrary to Hunt's claim, A&E visits didn't soar after the GP contract, only increasing by the 1% or 2% expected with an ageing population, according to the government's own Emergency Care Review. Lest Hunt forgets, Labour left the NHS with virtually no waiting lists for operations or long A&E waits, and patient satisfaction at the highest ever recorded. Hunt's attempt to blame the GP contract is, even by his standards, an eye-watering, breathtaking economy with the truth.
A&E pressure has risen sharply recently for obvious reasons. GPs are good value as gatekeepers to hospitals – a system envied by continental services where patients take themselves straight to costly specialists. But the government ignored warnings about giving professionals too much power over their own services. While most GPs were indignantly opposed to the privatising reforms, a few entrepreneurial types seized the chance to run care-commissioning groups: nothing stops them sending patients to private clinics that they have invested in. Some GPs never liked competition from Labour's walk-in and urgent treatment centres, so these are being cut back, with 26 closing altogether – though they prevent far more expensive A&E visits. Lord Darzi's plan for polyclinics to ease pressure on hospital outpatients was abandoned: GPs prefer keeping their own premises.A&E pressure has risen sharply recently for obvious reasons. GPs are good value as gatekeepers to hospitals – a system envied by continental services where patients take themselves straight to costly specialists. But the government ignored warnings about giving professionals too much power over their own services. While most GPs were indignantly opposed to the privatising reforms, a few entrepreneurial types seized the chance to run care-commissioning groups: nothing stops them sending patients to private clinics that they have invested in. Some GPs never liked competition from Labour's walk-in and urgent treatment centres, so these are being cut back, with 26 closing altogether – though they prevent far more expensive A&E visits. Lord Darzi's plan for polyclinics to ease pressure on hospital outpatients was abandoned: GPs prefer keeping their own premises.
Tony Blair, assailed by an angry patient in the 2005 election, obliged GPs to open on a Saturday or at least one evening, and three-quarters did. But this government, when it was wooing GPs, abandoned the monitoring of their hours, since when over half of surgeries have cut opening times. Last year the numbers offering evenings and Saturdays dropped by almost 6%. You may remember that Cameron promised in the Mail just before the election: "You will be able to see a GP in your area until 8pm, seven days a week". Instead there are too few GPs to cope with a growing need, and many are overworked.Tony Blair, assailed by an angry patient in the 2005 election, obliged GPs to open on a Saturday or at least one evening, and three-quarters did. But this government, when it was wooing GPs, abandoned the monitoring of their hours, since when over half of surgeries have cut opening times. Last year the numbers offering evenings and Saturdays dropped by almost 6%. You may remember that Cameron promised in the Mail just before the election: "You will be able to see a GP in your area until 8pm, seven days a week". Instead there are too few GPs to cope with a growing need, and many are overworked.
Labour's successful NHS Direct staffed by nurses was recklessly replaced with 111's clueless call-centre operators. That swelled numbers referred to A&E by a third. "Teething problems", says Hunt, but 111 may never win public trust, as 40% abandon their calls to it in some areas. South East Coast Ambulances Service staff say callouts have doubled as inept operators send them out to trivial complaints. Ambulances queue outside A&E, and only half of hospitals hit the government's lower waiting target: no surprise in the 50% drop-out rate for young doctors in emergency medicine. Patients wait on trolleys in A&E partly because there are 6% fewer hospital beds than in 2010. Consultants warned the Commons this week that occupancy was dangerously near 100% .Labour's successful NHS Direct staffed by nurses was recklessly replaced with 111's clueless call-centre operators. That swelled numbers referred to A&E by a third. "Teething problems", says Hunt, but 111 may never win public trust, as 40% abandon their calls to it in some areas. South East Coast Ambulances Service staff say callouts have doubled as inept operators send them out to trivial complaints. Ambulances queue outside A&E, and only half of hospitals hit the government's lower waiting target: no surprise in the 50% drop-out rate for young doctors in emergency medicine. Patients wait on trolleys in A&E partly because there are 6% fewer hospital beds than in 2010. Consultants warned the Commons this week that occupancy was dangerously near 100% .
Talk of getting people out of hospital and into the community is wildly unrealistic when social care is deeply cut. Last year there were 118,000 "bed-blockers", people waiting in hospital for lack of community care or a home to go to. Protecting the NHS budget comes at the price of a massacre of local authority spending, so the frail getting inadequate 15-minute care visits end up in a crisis needing hospital treatment. Benefit cuts that shunt at least 660,000 families away from their GPs into distant temporary housing add to A&E visits.Talk of getting people out of hospital and into the community is wildly unrealistic when social care is deeply cut. Last year there were 118,000 "bed-blockers", people waiting in hospital for lack of community care or a home to go to. Protecting the NHS budget comes at the price of a massacre of local authority spending, so the frail getting inadequate 15-minute care visits end up in a crisis needing hospital treatment. Benefit cuts that shunt at least 660,000 families away from their GPs into distant temporary housing add to A&E visits.
Sir David Nicholson, NHS England head, was the last glue holding together this organisational chaos, so losing him to the wolves of the Mail, Telegraph, Times and Sun should deeply alarm the government. He was hounded for the Mid Staffs scandal, though was not blamed in the Francis report. His real sin was to know (and almost say) that Lansley's plan was a disaster in the making, but instead of blowing the whistle he tried to make it work. Fragmenting the service with private competition is no way to secure the NHS in hard times. The only hope is by binding health and social services budgets together, as Labour proposes. Easy to say, hard to do.Sir David Nicholson, NHS England head, was the last glue holding together this organisational chaos, so losing him to the wolves of the Mail, Telegraph, Times and Sun should deeply alarm the government. He was hounded for the Mid Staffs scandal, though was not blamed in the Francis report. His real sin was to know (and almost say) that Lansley's plan was a disaster in the making, but instead of blowing the whistle he tried to make it work. Fragmenting the service with private competition is no way to secure the NHS in hard times. The only hope is by binding health and social services budgets together, as Labour proposes. Easy to say, hard to do.
Jeremy Hunt takes a risk in gunning for GPs, walloping them with a "rigorous" new chief inspector. What chutzpah to talk of cutting their red tape so they can "care", just as hefty commissioning duties are foisted on them. How will he give GPs back out-of-hours duties, just as clinical commissioning groups put them out to private tender? Hunt was put there to stop NHS noise and halt closures before the election, but this blundering blaming of GPs is bad politics. Who will the public trust? History is not on his side.Jeremy Hunt takes a risk in gunning for GPs, walloping them with a "rigorous" new chief inspector. What chutzpah to talk of cutting their red tape so they can "care", just as hefty commissioning duties are foisted on them. How will he give GPs back out-of-hours duties, just as clinical commissioning groups put them out to private tender? Hunt was put there to stop NHS noise and halt closures before the election, but this blundering blaming of GPs is bad politics. Who will the public trust? History is not on his side.
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