Why I’m stepping down as a GP over NHS ‘reforms’

Published by the Guardian today, written by Dr Paul Hobday.

One of the first articles I put on this blog, under ‘comprehensive guides to the NHS proposals’, was Dr Hobday’s comment on the BBC website here. You can see he has been watching this coming for a long time …

It’s been an amazing privilege working as a family doctor. I am trusted with the long-term care and health of sometimes four generations, and I have tried to help with their most intimate and complex problems, sometimes shared only with me. It’s the best job in medicine, and the NHS was the best place to practice.

So why am I retiring early? Because for several years I’ve fought the dismantling of the founding principles of Bevan’s NHS and on 1 April I lost. That was the day the main provisions of the Health and Social Care Act 2012 came into effect. On Wednesday night, a last-gasp attempt in the House of Lords to annul the part pushing competitive tendering sadly failed.

The democratic and legal basis of the English NHS and the secretary of state’s duty to provide comprehensive health services have now gone, and the framework that allows for wholesale privatisation of the planning, organisation, supply, finance and distribution of our health care is now in place. Since 1948, we GPs have been our patient’s advocate, championing the care we judge is needed clinically.

Everyone necessary for that care co-operated for the good of the patient – they didn’t compete for the benefit of shareholders. Sadly, patients are now right to be suspicious of motives concerning decisions made about them, which until recently, almost uniquely in the world, have been purely in their best clinical interest. Most politicians understand little about general practice, have no idea about the importance of continuity of care and blame GPs for a rise in hospital work, even though this is a direct result of their policies.

I believe patient choice is an illusion as I am restricted in terms of where I can refer and what treatments I can use. GPs are now expected tocollude with rationing, are sent incomprehensible financial spreadsheets telling us our “activity levels” are too high and in some areas areprevented from speaking out about this, despite the government’s weasel words about duty of candour after Mid Staffs. Practices are already being solicited by private companies touting for business, often connected to members of my own profession. But the lie that GPs are now in control of the money will soon be exposed. Most services are to go out to tender, which will paralyse decision-making.

Now your doctor, the hospital, your specialist or the employing company has a financial incentive built into the clinical decision-making – even whether or not you are seen at all. Your referral may be to a related company, with both profiting from your care – so was that operation, procedure or investigation really in your best clinical interest? Or you may be told a service is now no longer available. The jargon used is that “we are not commissioned for that”. But you can pay. The elephant in the consulting room is the ethical implication of private medicine. In my 30 years as an NHS GP, some of the most disastrously treated patients are those who elected for private care. Decisions were made about them for the wrong reasons, namely profit. Patients are rarely aware of this.

The politicians who drive this unnecessary revolution claim the NHS is not being privatised because it is still free at the point of use. This is duplicitous as the two are not connected. They are ignorant or dismissive of the founding principles of the NHS which include it being universal and comprehensive – both of which have gone. The NHS logo appears on all sorts of private company buildings and notepaper which is one reason patients haven’t noticed the change yet. Just leaving “free at the point of use” under an NHS kitemark doesn’t constitute a national health service. It’s now one small step to insurance companies picking up the bill (but obviously profiting from it) rather than the state. An Americanised system run by many US companies. The end of a “60-year-old mistake”, asJeremy Hunt once co-authored.

I am proud to have been an NHS GP. I believe the way a society delivers its healthcare defines the values and nature of that society. In the US, healthcare is not primarily about looking after the nation’s health but a huge multi-company, money-making machine which makes some people extremely rich but neglects millions of its citizens. We are being dragged into that machine and I want no part in it.

The politicians responsible for this must live with their consciences, as it is the greatest failure of democracy in my lifetime.

6 responses to “Why I’m stepping down as a GP over NHS ‘reforms’

  1. Sadly, two of my favourite NHS Consultants left the NHS on the same day. They are still available for consultations, but now patients have to pay. I have decided my health is too important to save money on – so went to see one Consultant last week. Was met by smiling doc, apologising profusely that he had kept me waiting (FIVE minutes!) and gave me 30 minutes of superb, undivided attention. Worth every hard-earned penny!

    But I have a small amount of money in bank – feel sorry for those who don’t.

  2. As an American Family Physician, I believe that the ethical behavior of a physician is not dependent on the payment method. Character of physicians has opportunities to show better under duress. If one is convinced that they will sell out their ethical principles if exposed to a change in reimbursement, that is disappointing, but it’s good to know oneself.
    We will continue to be tested and tempted in all systems of practice.

    • I agree to a large extent, I’ve worked with deeply committed doctors in Afghanistan and Nepal where the incentives work completely against patients’ interests and I’m aware of many wonderful doctors working in the US. Having said that I think that healthcare systems do undoubtedly contribute to (un)ethical behaviour as levels of fraud in the US and maltreatment at Mid Staffs demonstrate. I think healthcare professionals owe it to our patients to continue working, no matter how bad the system, so long as we can continue to do good.

  3. Thing is some health workers have always had vested interests and could refer without question or transparency to services they wished to support for personal as well as purely clinical reasons; individuals had no choice at all over most of their health decisions…and without doubt those ‘in the know’ received better services…..it was not a golden age even if what is to come is pretty scary

  4. Problem is- the politicians HAVE no conscience. They just don’t care.

  5. I left the NHS, too on 1st April for almost identical reasons. I am volunteering as a medical officer working with displaced persons and migrants on the Thai – Myanmar border.

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