UK Politics
Bright ideas will damage Labour's health
Published 05 June 2008
Threatening GPs is bad politics
Here is another idea on which, I predict, ministers will have to beat an undignified retreat at some point over the next 18 months. They should know that closing institutions such as post offices, schools and hospitals brings nothing but trouble. Yet they intend shortly to threaten what the British treasure above all else: the local GP. It will start in London, but will eventually, to use a favourite new Labourism, be "rolled out" across the country.
The idea is to create "polyclinics" and, according to the health magazine Pulse, there are already plans to close more than 100 GP surgeries across London to make way for them. They will be health clinics, where a score or more GPs might work alongside dentists, cardiologists, nutritionists, physiotherapists, psychiatrists, pharmacists, nurses and a host of others, including social care providers. Services now found in hospitals will move closer to the community, the government argues. Many tests, consultations and minor operations for which patients now go to hospital could be done locally. Many conditions that GPs, as generalists, find difficult to identify will be spotted more quickly by a wider range of experts on the front line.
Polyclinics, moreover, will open at weekends and evenings. They will be one-stop shops for most families' health-care needs, most of the time. More public convenience, less waste, swifter test results, less misdiagnosis, more professional partnership, less MRSA (possibly): it sounds like a win, win, win.
Unfortunately, that is not how the public will see it. As always, people will feel the loss - in this case of the "family doctor" - more than they appreciate any gain - in this case, more expert and reliable service. Until ministers understand this, they will continue to lose public confidence. When, more than 50 years ago, a splinter embedded in my thumbnail threatened one Saturday evening to turn gangrenous, I was taken to the doctor's home, where he deftly extracted it after finishing his tea (as we called it in the Midlands). When my grandmother collapsed on Christmas Day, I was instructed to run (we had no telephone) to the same doctor's home; he was at my grandmother's bedside before I got back. Millions have similar stories embedded in their family folklore. The GP is part of the fabric of British life. He or she often wasn't much good, but was a reassuring figure all the same. Harold Shipman was still revered by many of his patients, even after he had been convicted for multiple murders.
Polyclinics strike me as examples of the cult of gigantism that regularly afflicts those in power, and which they often live to regret.
Secondary schools of 2,000 pupils, tower blocks, merged local councils: politicians set about these projects with a will, quoting advantages in "efficiency", only to find they eventually have to reverse them. But I can see the case for polyclinics, and I am happy, for now, to be intellectually agnostic.
I am not, however, politically agnostic. Of all professionals, GPs have the most intimate and most frequent contact with the public.
In all surveys of who is trusted to tell the truth - there was another from YouGov the other day - family doctors come top as inevitably as estate agents come bottom. When GPs' surgeries are threatened with closure, ministers won't have a hope of winning the argument.
Moreover, their opponents have one genuinely powerful point: polyclinics look like another step towards NHS privatisation. Primary care trusts will invite tenders to run them, using the Alternative Provider Medical Services contracting route (a mouthful, but you know what it means). Even if they can raise capital, groups of GPs will most likely be undercut by big corporates such as Alliance Boots, Bupa and, yes, the ubiquitous Tesco.
The Tories won't oppose privatisation. But David Cameron is playing the tunes to embarrass the government. In April, he said that people "like to rely on the doctor they know, at the end of their street, often in a building not much bigger than a house". This may be romantic nonsense - how many people ever had a doctor at the end of their street? - but it catches the public mood. Just as they want bobbies on the beat, and no amount of evidence that police foot patrols don't cut crime will convince them otherwise, so they want Dr Finlay a few minutes' walk away.
Dozens of polyclinics are planned to start next year. Expect a mighty row. When the economy is healthy and poll ratings are rising, governments can get away with anything. But when things are going badly, backbenchers, more fearful for their seats than they are hopeful of preferment, are sitting ducks for any concerted lobbying campaign.
I know this is the thinking column. But my advice to ministers, at this grim moment, is to stop playing with bright ideas, which always bring trouble, and use their political nous.
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