In this week's magazine, Clare Gerada, physician and chairman of the Royal College of General Practitioners, talks to the New Statesman's Sophie Elmhirst about her fears for the future of the NHS, David Cameron's betrayal, and the ways in which patients will suffer as a result of Health Secretary Andrew Lansley's reforms:
We've got three big things going on at the same time - a massive reorganisation of the health service, alongside a serious financial situation, alongside the NHS having to make £20bn efficiency savings. So it is difficult to say which one is going to cause "X, Y, Z", but certainly patients are going to experience longer waiting lists; they'll see less choice available. Irrespective of whether the government says there is going to be more choice: there won't be more choice.
In line with the General Practitioners' Committee's stance against the reform bill's Quality Premium, Gerada is outspoken about performance-related bonuses for GPs:
In the [reform] bill, the government is suggesting that GPs be rewarded for keeping in budget. There is no problem in GPs having an incentive to practise good, evidence-based medicine. Where it becomes a step too far is where we are rewarded for keeping patients out of hospital. Because you have to trust me, you have to trust that I have stopped you from going to hospital because it is in your best interests, not because I am going to get £10, £15, £20 or whatever it is. And that begins to distort the doctor/patient relationship, which has to be fundamentally built upon trust -- otherwise what's the point of it?
Gerada speaks of being "absolutely surprised" by the reforms proposed by a coalition government she has had no discussions with:
Like others, I heard David Cameron say "no top-down reorganisation of the NHS". I was so relieved, because I had lived through 15 reorganisations . . . [But this reform] isn't so much putting GPs in charge of commissioning, but about dismantling the systems and the architecture of the NHS.
The NHS is our NHS. It is one of the last things that we as the people - the taxpayers - own, and by owning it our Health Secretary and our parliament is responsible for it. For £120 billion of taxpayers' money, somebody has to be accountable to parliament. . . . It is symbolic if [Health Secretary Andrew Lansley] is no longer accountable for our national health service.