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What’s up, Doc?
The Economist, May 3rd 2001
Doctors seem determined to embarrass the government. Has Labour promised too much?
THERE was at least one protest on May 1st, which provoked public sympathy. Though unspectacular, it was symptomatic. The demonstrators in question were general practitioners (GPs), a few of whom downed their stethoscopes and prescription pads in anger at their lot. Such eruptions of medical disgruntlement threaten the government’s ambitions for the health service.
Ministers have already alienated hospital consultants with their plans to restrict their right to practise privately—a proposal that the British Medical Association
(BMA) says may be illegal. And more serious militancy than the wildcat protest on May Day is yet to come: the BMA is asking all GPs if they would consider resigning, should a new contract not be agreed with the government by next April. The ballot’s result should be ready, awkwardly for the government, just in time for the election.
It wasn’t supposed to be this way. Last July, Tony Blair published a ten-year master-plan for the
NHS. Its aspirations ranged from reduced waiting times to improving hospital food. Dissenting voices wondered about the plan’s feasibility and radicalism, but the medical professions were supportive. Yet now concerns about health care, which helped propel Labour to office at the last election, threaten to embarrass it at the forthcoming one.
In the case of GPs, the government may be more spinned against than sinning. The dissidents say that bureaucratic burdens, new political targets, rising patient expectations and evolving medical treatments are conspiring to make their jobs impossible, and to damage patient care: average time per patient is now around eight or nine minutes. Worse, retirements and inadequate recruitment will exacerbate the problem. The government’s plan says it wants to recruit 2,000 more GPs for England by 2004—a target the BMA says is unlikely to be achieved and is in any case grossly inadequate. The target for consultants is 7,500. Mike Pringle, chairman of the Royal College of General Practitioners, says family doctors worry that politicians concentrate too much on “consultants, sexy new units and cardiac surgery”, when the vast majority of care takes place in GPs’ surgeries and patients’ homes.
But as Steve Gillam, a GP and analyst at the King’s Fund, a health think-tank, says, many of the problems besetting general practice are long-term. Labour has introduced “golden hellos” of £5,000 for new GPs, incentives for retiring ones to stay on, and measures to cut doctors’ paper-work. Official figures suggest that GPs now undertake fewer consultations and out-of-hours visits than was the case a decade ago. As with the bust-up with consultants, some GPs view the new-style contract that the government wants them to sign as a slur on their professional integrity. But reform of their terms of service is overdue.
Ministers have earned some unpopularity by concentrating power in Whitehall, and through the relentless edicts they have issued. In his
defence, Alan Milburn, the health secretary, argued last week that Labour’s strategy has been to establish national standards in its first term, before devolving power in its second. To do so, and to prune NHS bureaucracy, Mr Milburn said the number of local health authorities would gradually be reduced by two-thirds; more decisions will be taken by GPs themselves, through the primary-care trusts into which they have been grouped.
However, Mr Milburn’s proposals are an over-hyped re-announcement of existing policy, and should be treated
sceptically. His two-term strategy looks like a belated acceptance that central diktats are not the best way to motivate professionals. Promises to cut red tape are always popular; but in reality the new arrangements will mean either that doctors do more of the paper-work they are so cross about, or—more likely—that bureaucrats are shuffled around the system. The effect of reducing the number of health authorities could be to increase rather than reduce
centralisation. Most important, there could be tension between the goal of liberating local talent and the ideal of equity across the
NHS, so dear to the public.
The anger of doctors—along with the consequences of Labour’s relative parsimony during its first two years in office, and the early deployment of its big ideas—have made health an awkward subject for the government. Ministers have learned the hard way that promising too much—to both voters and employees—can be as perilous as promising too little. |
