Under plans being considered by ministers, GPs in affluent parts of England could be barred from taking jobs in wealthy areas to force them to work in deprived areas, in a bid to address health inequalities. The solution to doctor shortages, apparently, is to make the job less attractive.
This would be the healthcare equivalent of the government taking charge of the hospitality industry and informing the owners of the Ivy that all new restaurants should be located in towns north of the Watford Gap, to ensure the pleasures of fine dining are evenly enjoyed across the country. And yet the Social Market Foundation (SMF) who put forward this proposal is suggesting that where GPs work should no longer be a matter for GPs and the practices that employ them.
The trouble is that our system of national pay bargaining and centralised control over healthcare inevitably leads to crises and shortages in some areas – just as it did in the Soviet Union. In some areas, such as nursing, the shortages are in affluent areas because bargaining prevents wages reflecting local (i.e. higher) prices. The relative costs and attractions of working in affluent and deprived locations are not reflected in the payments made to GPs or the practices that employ them.
This would be the healthcare equivalent of the government taking charge of the hospitality industry
But greater state control is not the solution to the fact that there is now one GP per 1,688 patients in Oxfordshire compared with 1 to 4,480 in Blackpool North (although the former is still among the worst areas for seeing patients in person). Restricting where GPs live and work should not be the response to a failed, centralised model.
Fixating on regional disparities or face-to-face appointments when there could be a deficit of 400,000 doctors across 32 OECD countries by 2030 is a bit like worrying about the cigarette burn on the sofa when your house is on fire. Already, the UK has just 2.8 doctors per 1,000 population, putting us well below the EU average (3.4/1,000), with only four countries in Europe having lower numbers per capita.
We now rely more heavily on foreign-trained physicians than comparable countries. And while the number of people applying to study medicine shot up 21 per cent recently, over half of doctors surveyed recently are planning to either retire early or spend less time in clinical practice. Only 37 per cent of physicians currently completing their foundation years are going straight into training.
And what will lure foreign, newly-qualified doctors scoping out opportunities across countries onto UK soil? We might bang our pots and pans for them when a crisis hits, but they’ll be choosing a system not just with fewer doctors, but fewer hospital beds, nurses and MRI machines. A health service whose performance, in international comparisons, almost always ranks in the bottom third. A system that isn’t poorly funded by international standards, but is more bureaucratic and wasteful.
For months now, this government has claimed to hold liberal values while presiding over draconian restrictions on our liberties in the name of protecting the NHS. It has fed the delusion that our healthcare system is the best in the world, making the prospect of meaningful reform even more distant. Its levelling up agenda was supposed to be about creating jobs and opportunity, not restricting where the brave souls who work within the NHS can live.
‘A GP would realise they wouldn’t be allowed to work in that over-doctored area, and would decide to work somewhere that was under-doctored instead,’ the SMF writes. Perhaps, or maybe a doctor would decide instead to work overseas. Or change specialty. Or pursue a different career entirely. Tory politicians who claim to believe in free markets while disregarding the law of unintended consequences are either fooling us – or themselves.
In East Germany, the government allocated graduates their first jobs; they had no say in the matter. If we want to attract more doctors to plug forthcoming gaps, this really isn’t the example to follow. Instead, we should decentralise and decouple from politics any decisions over pay, working hours and working conditions. We should allow pay across the NHS to be negotiated by individual Clinical Commissioning Groups, Trusts, and the representatives of various health professions.
If politicians don’t grasp the nettle and accept the need for change, the NHS’s problems will always be patched up with imprudent schemes just like this.
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