Witney GP: "Nobody supports the NHS changes"

Senior GP in David Cameron's own constituency tells New Statesman "things are going to fail, hospita

In an exchange over the government's controversial health reforms at Prime Minister's Questions last Wednesday, David Cameron cited "a supportive GP . . . who hails from Doncaster [Ed Miliband's constituency]".

In this week's New Statesman (on newsstands tomorrow), Sophie Elmhirst travels to David Cameron's own Witney constituency in West Oxfordshire, where a senior partner of a local GP practice tells her:

"I would say very few GPs are happy with [the NHS reform] at all . . . Not a question of supporting it, it's a question of going along with it."

"In my practice, nobody supports the changes . . . people think there should be more clinical involvement in commissioning. But I don't think many people think that GPs are the right people to commission. They need input into it - but if we wanted to be managers we would have trained to be managers, not doctors. "

The GP adds:

"Most GPs are incredibly worried about conflict of interest. How can you be a patient's advocate and look after the money? A lot of people think the whole thing's designed to fail so they can bring private providers in. It's the one big bit of the economy that hasn't got private money in it."

Of the effects to patients from the health service overhaul, the Witney GP says:

"The public have just got no idea what's hitting them . . . Things are going to fail, hospitals will close, because the money's not going to be there. Things will get taken over. And if you're going to have to make a profit out of it, you're not going to have the same service."

In the same report, Elmhirst speaks to Dr Paul Roblin, the chief executive of Berkshire, Buckinghamshire & Oxfordshire Local Medical Council, which covers Cameron's Witney constituency. Speaking about the health and social care bill, currently working its way through the House of Lords, Roblin, a retired GP, says:

"It's a major change which is quite experimental at a time when the NHS is trying hard to save money. The timing doesn't seem to be good. Among GPs there's a huge spectrum of enthusiasm from those that think commissioning will work to those who think that think it's another fad in the NHS and will soon pass."

"There is a large bulk in middle just watching events, and waiting to see what happens. [They are] slightly perturbed - they didn't go into medicine to do that sort of thing [commissioning] and it's a distraction from actually seeing patients."

"Many GPs are fed up with continual NHS restructuring.... The actual job... takes a back seat for many years while the restructuring is taking place. It's a very wasteful process."

Roblin issues a personal message to the prime minister:

"Produce an environment where people within the NHS can concentrate on what really matters which is patient care rather than structural reorganisation. Because continual change is draining and wasteful. They describe it as modernisation. I think they should stop using that political euphemism."

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Scotland's vast deficit remains an obstacle to independence

Though the country's financial position has improved, independence would still risk severe austerity. 

For the SNP, the annual Scottish public spending figures bring good and bad news. The good news, such as it is, is that Scotland's deficit fell by £1.3bn in 2016/17. The bad news is that it remains £13.3bn or 8.3 per cent of GDP – three times the UK figure of 2.4 per cent (£46.2bn) and vastly higher than the white paper's worst case scenario of £5.5bn. 

These figures, it's important to note, include Scotland's geographic share of North Sea oil and gas revenue. The "oil bonus" that the SNP once boasted of has withered since the collapse in commodity prices. Though revenue rose from £56m the previous year to £208m, this remains a fraction of the £8bn recorded in 2011/12. Total public sector revenue was £312 per person below the UK average, while expenditure was £1,437 higher. Though the SNP is playing down the figures as "a snapshot", the white paper unambiguously stated: "GERS [Government Expenditure and Revenue Scotland] is the authoritative publication on Scotland’s public finances". 

As before, Nicola Sturgeon has warned of the threat posed by Brexit to the Scottish economy. But the country's black hole means the risks of independence remain immense. As a new state, Scotland would be forced to pay a premium on its debt, resulting in an even greater fiscal gap. Were it to use the pound without permission, with no independent central bank and no lender of last resort, borrowing costs would rise still further. To offset a Greek-style crisis, Scotland would be forced to impose dramatic austerity. 

Sturgeon is undoubtedly right to warn of the risks of Brexit (particularly of the "hard" variety). But for a large number of Scots, this is merely cause to avoid the added turmoil of independence. Though eventual EU membership would benefit Scotland, its UK trade is worth four times as much as that with Europe. 

Of course, for a true nationalist, economics is irrelevant. Independence is a good in itself and sovereignty always trumps prosperity (a point on which Scottish nationalists align with English Brexiteers). But if Scotland is to ever depart the UK, the SNP will need to win over pragmatists, too. In that quest, Scotland's deficit remains a vast obstacle. 

George Eaton is political editor of the New Statesman.