Royal College of GPs chair attacks NHS reforms

Clare Gerada tells the <em>New Statesman</em>: "This reform is so large you can see it from outer sp

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.

Alice Gribbin is a Teaching-Writing Fellow at the Iowa Writers' Workshop. She was formerly the editorial assistant at the New Statesman.

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I'll vote against bombing Isis - but my conscience is far from clear

Chi Onwurah lays out why she'll be voting against British airstrikes in Syria.

I have spent much of the weekend considering how I will vote on the question of whether the UK should extend airstrikes against Daesh/Isis from Iraq to Syria, seeking out and weighing the evidence and the risks.

My constituents have written, emailed, tweeted, facebooked or stopped me in the street to share their thoughts. Most recognised what a difficult and complex decision it is. When I was selected to be the Labour candidate for Newcastle Central I was asked what I thought would be the hardest part of being an MP.

I said it would be this.

I am not a pacifist, I believe our country is worth defending and our values worth fighting for. But the decision to send British Armed Forces into action is, rightly, a heavy responsibility.

For me it comes down to two key questions. The security of British citizens, and the avoidance of civilian casualties. These are separate operational and moral questions but they are linked in that it is civilian casualties which help fuel the Daesh ideology that we cannot respect and value the lives of those who do not believe as we do. There is also the important question of solidarity with the French in the wake of their grievous and devastating loss; I shall come to that later.

I listened very carefully to the Prime Minister as he set out the case for airstrikes on Thursday and I share his view that Daesh represents a real threat to UK citizens. However he did not convince me that UK airstrikes at this time would materially reduce that threat. The Prime Minister was clear that Daesh cannot be defeated from the air. The situation in Syria is complex and factionalised, with many state and non-state actors who may be enemies of our enemy and yet not our friend. The Prime Minister claimed there were 70,000 ground troops in the moderate Free Syrian Army but many experts dispute that number and the evidence does not convince me that they are in a position to lead an effective ground campaign. Bombs alone will not prevent Daesh obtaining money, arms and more recruits or launching attacks on the UK. The Prime Minister did not set out how we would do that, his was not a plan for security and peace in Syria with airstrikes a necessary support to it, but a plan to bomb Syria, with peace and security cited in support of it. That is not good enough for me.

Daesh are using civilian population as human shields. Syrians in exile speak of the impossibility of targeting the terrorists without hitting innocent bystanders. I fear that bombing Raqqa to eliminate Daesh may be like bombing Gaza to eliminate Hamas – hugely costly in terms of the civilian population and ultimately ineffectual.

Yet the evil that Daesh perpetrate demands a response. President Hollande has called on us to join with French forces. I lived in Paris for three years, I spent time in just about every location that was attacked two weeks ago, I have many friends living in Paris now, I believe the French are our friends and allies and we should stand and act in solidarity with them, and all those who have suffered in Mali, Kenya, Nigeria, Lebanon, Tunisia and around the world.

But there are other ways to act as well as airstrikes. Britain is the only G7 country to meet its international development commitments, we are already one of the biggest humanitarian contributors to stemming the Syrian crisis, we can do more not only in terms of supporting refugees but helping those still in Syria, whether living in fear of Daesh or Assad. We can show the world that our response is to build rather than bomb. The Prime Minister argues that without taking part in the bombing we will not have a place at the table for the reconstruction. I would think our allies would be reluctant to overlook our financial commitment.

We can also do more to cut off Daesh funding, targeting their oil wells, their revenues, their customers and their suppliers. This may not be as immediately satisfying as bombing the terrorists but it is a more effective means of strangling them.

The vast majority of the constituents who contacted me were against airstrikes. I agree with them for the reasons I set out above. I should say that I have had no experience of bullying or attempts at intimidation in reaching this decision, Newcastle Central is too friendly, frank, comradely and Geordie a constituency for that. But some have suggested that I should vote against airstrikes to ensure a “clear conscience” ’. This is not the case. There will be more killings and innocent deaths whether there are UK airstrikes or not, and we will all bear a portion of responsibility for them.

A version of this article was originally sent to Chi Onwurah's constituents, and can be read here