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The medics' union is doing its usual

Monday, 4th February 2008

You have to hand it to the BMA. They are, by quite a long way, the most effective trades union in the land. I've written about this before (here); as I put it then:

[T]here is no interest group that comes close to the British Medical Association. When trade union officials speak, we know what they are up to. They are trying to increase their influence and power. And we judge the sense of what they say accordingly.
The BMA is, except in one crucial respect, no different. It is like any other trade union, with the same overriding motivation: to increase its influence and power. The crucial difference, however, is that when the prefix “Doctor” is attached to a name, we lose our critical faculties. We assume that anything emanating from the BMA is disinterested and motivated only by the desire to increase the sum of human good.

They're at it again, resisting the Health Secretary's request for GPs to open at times that might be convenient for their patients with spurious arguments about their dedication to the public good and claims (not backed by any evidence) that the average GP works non stop from 8.30 to 6.30.

GPs are the single most striking example of how not to run a public service.

They are - thanks to a clever piece of stitching up the government over the GPs' contract - over-paid and without any incentive to serve the very people who enable them to earn that money. Instead of being paid in response to the satisfaction of patient need, they are effectively handed over vast sums of taxpayers' money and then left free to offer what services they see fit to offer. Yes, most of them are technically independent contractors rather than NHS employees, but that has little bearing on how they operate.

It's one thing - and quite right - to blame the government for its inept handling of the contract negotiations. But that's dealing with the symptom of the problem, not its real cause. The only real answer is to put the patient in control so that doctors have to respond to their clients, rather than their clients being at the mercy of doctors (which is, of course, the larger NHS problem writ small).

Charging patients for GP visits has long been bandied around, but mainly for the wrong reason. It's usually acdvocated to cut patient no-shows. But the real reason is to give the patient power.

I have a private GP. I pay £45 a visit. In return, he is available when I want him, and has to respond to my needs. If NHS patients paid their GP, they too would be in control and the GP would seek to attract that custom through, for example, opening at times which suit the patient rather than when the doctor fancies opening.

This could be done in two ways: either straighforwardly having a fee to visit the doctor (which might be means tested, so the poor would not actually have to hand over money); or preferably as part of a more general reconstruction of the NHS which would deal with the wider problem of patients being at the mercy of a giant government institution, and would give patients overall control of their budget, through some form of Medical Savings Account.

The one thing we shouldn't do is listen to the BMA's claims of over work and customer service. Any more than we should fall for any other union's claims that its members are outstanding servants of the public's good.

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Jennie

February 4th, 2008 4:47pm

I wonder if a private GP system would stop the bat-and-ball between GPs and hospital outpatient clinics. Where the clinic tells the patient: oh, your GP can do that (say, give a cortisone injection). And the GP responds by informing the patient: oh no, we have neither the resources nor the expertise - you'll have to ask the clinic.

A Consultant Surgeon

February 4th, 2008 4:48pm

Hear Hear!

C.W.

February 4th, 2008 11:38pm

That's a great idea! I am a GP and I did just over 10000 consultations last year, excluding home visits. If I were paid £45 per consultation I would earn £450,000 per annum.

Dr Mark Pasola

February 5th, 2008 12:07am

Spare us your cheap cynicism about GP hours Stephen. Since you have no idea what we do outside consultation hours, you are poorly placed to sneer. My days as a GP are often considerably longer than 08.3-0 to 18.30 and I also challenge you compare the intensity of your job (or that of most people actually), and the risk and responsibility taken with mine. (Sneering again? That is because you are ignorant) Bizarrely, although you seem to know almost nothing about what GPs do or their Byzantine contractual terms, you have arrived on the right solution for Primary Care - to free it from the yoke of the state. GPs are sick of working for the government and many would love to be able to practice on a fee-for-service basis. A consumer-provider relationship would also replace the ludicrously inefficient apparatus of the state which exists to regulate measure and performance-manage the minutiae of our working lives.