It seems that despite the best efforts of an unlikely coalition of the wise, the cautious and the ideological of all political persuasions, the majority of GPs, thanks in large part to the appeasement efforts of the BMA, will go along with the Health White Paper.
Richard Holloway, ex-bishop of Edinburgh boiled down the Christian message to 3 principles in his book ‘Doubts and Loves, What’s left of Christianity’:
Stand up for the oppressed, stand up to authority and seek understanding rather than judgement.
These seemed like 3 sound guiding principles for a doctor of medicine. Sadly my peers are prepared only to stand up for their patients in the confines of a clinical relationship but not in the more general context of the social, economic and political reality in which they live, and which, as we all now know, is not only getting worse, (and here and here)
…but more importantly determines their health far more than any of the medical interventions we have to offer.
Unless we have a [moral] revolution which leads to a majority (a significant minority do this already) of doctors prepared to challenge the systems that lead to the social determinants that cause their patients illnesses, we’re unlikely to see doctors voting for a change that puts the needs of their most vulnerable patients first.
We need to examine the white paper in the context of widening health inequalities and the needs of our most vulnerable patients, which means we have to prioritise:
continuity of primary care, not the endless choice of a healthcare market
Better collaboration between primary and secondary care, not the competition of commissioning
stability of services, not the continual birth, death and rebirth of market driven services,
diversion of resources to the most deprived areas taking into account not only the clinical needs but also the complexity of caring for people with socially determined problems, not simply the diversion of resources to the most efficient/ easily run areas
Psychology, chronic disease management and drug and alcohol services, not homeopathy and other choices of the not terribly ill
Longer appointments with expert clinicians, not any time, any where appointments with any clinician
Better use of NICE to ensure a raising of clinical standards and far more widespread adherence to best practice guidelines, not increased clinical freedom: the failure to adhere to guidelines is far worse than the rare, but highly publicised cases where quite reasonably clinicians may wish to deviate but cannot.