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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Will Euroscepticism prove an unbeatable advantage in the Conservative leadership race?

Conservative members who are eager for Brexit are still searching for a heavyweight champion - and they could yet inherit the earth.

Put your money on Liam Fox? The former Defence Secretary has been given a boost by the news that ConservativeHome’s rolling survey of party members preferences for the next Conservative leader. Jeremy Wilson at BusinessInsider and James Millar at the Sunday Post have both tipped Fox for the top job.

Are they right? The expectation among Conservative MPs is that there will be several candidates from the Tory right: Dominic Raab, Priti Patel and potentially Owen Paterson could all be candidates, while Boris Johnson, in the words of one: “rides both horses – is he the candidate of the left, of the right, or both?”

MPs will whittle down the field of candidates to a top two, who will then be voted on by the membership.  (As Graham Brady, chair of the 1922 Committee, notes in his interview with my colleague George Eaton, Conservative MPs could choose to offer a wider field if they so desired, but would be unlikely to surrender more power to party activists.)

The extreme likelihood is that that contest will be between two candidates: George Osborne and not-George Osborne.  “We know that the Chancellor has a bye to the final,” one minister observes, “But once you’re in the final – well, then it’s anyone’s game.”

Could “not-George Osborne” be Liam Fox? Well, the difficulty, as one MP observes, is we don’t really know what the Conservative leadership election is about:

“We don’t even know what the questions are to which the candidates will attempt to present themselves as the answer. Usually, that question would be: who can win us the election? But now that Labour have Corbyn, that question is taken care of.”

So what’s the question that MPs will be asking? We simply don’t know – and it may be that they come to a very different conclusion to their members, just as in 2001, when Ken Clarke won among MPs – before being defeated in a landslide by Conservative activists.

Much depends not only on the outcome of the European referendum, but also on its conduct. If the contest is particularly bruising, it may be that MPs are looking for a candidate who will “heal and settle”, in the words of one. That would disadvantage Fox, who will likely be a combative presence in the European referendum, and could benefit Boris Johnson, who, as one MP put it, “rides both horses” and will be less intimately linked with the referendum and its outcome than Osborne.

But equally, it could be that Euroscepticism proves to be a less powerful card than we currently expect. Ignoring the not inconsiderable organisational hurdles that have to be cleared to beat Theresa May, Boris Johnson, and potentially any or all of the “next generation” of Sajid Javid, Nicky Morgan or Stephen Crabb, we simply don’t know what the reaction of Conservative members to the In-Out referendum will be.

Firstly, there’s a non-trivial possibility that Leave could still win, despite its difficulties at centre-forward. The incentive to “reward” an Outer will be smaller. But if Britain votes to Remain – and if that vote is seen by Conservative members as the result of “dirty tricks” by the Conservative leadership – it could be that many members, far from sticking around for another three to four years to vote in the election, simply decide to leave. The last time that Cameron went against the dearest instincts of many of his party grassroots, the result was victory for the Prime Minister – and an activist base that, as the result of defections to Ukip and cancelled membership fees, is more socially liberal and more sympathetic to Cameron than it was before. Don’t forget that, for all the worry about “entryism” in the Labour leadership, it was “exitism” – of Labour members who supported David Miliband and liked the New Labour years  - that shifted that party towards Jeremy Corbyn.

It could be that if – as Brady predicts in this week’s New Statesman – the final two is an Inner and an Outer, the Eurosceptic candidate finds that the members who might have backed them are simply no longer around.

It comes back to the biggest known unknown in the race to succeed Cameron: Conservative members. For the first time in British political history, a Prime Minister will be chosen, not by MPs with an electoral mandate of their own or by voters at a general election but by an entirelyself-selecting group: party members. And we simply don't know enough about what they feel - yet. 

Stephen Bush is editor of the Staggers, the New Statesman’s political blog. He usually writes about politics.