Tom Smith on today’s health policy debate.

Amongst today’s headlines includes the snappy, ‘super surgeries row rumbles on’ as well as the not so snappy, ‘Gordon Brown accuses doctors of ill founded allegations over polyclinics’. While many people will today be aware that the government has fallen out with doctors, they may still not be clear about why.

The politics of polyclinics

From an already low ebb, Jeremy Laurence in the Independent notes that tensions between the government and the medical profession ‘intensified’ yesterday, in the wake of the BMA petition, presented to Downing Street and the ‘go ahead’ given to a network of polyclinics in London.

Adding fuel to the fire, there are today reports that ‘a joint committee of the 31 primary care trusts in London approved plans to provide at least 150 of the super-surgeries with the first expected to open in April next year’. A spokesperson for the NHS suggested there would be a mix of models – some will be new premises and others will be based on networks of GPs.

The issue has become highly politicised and Gordon Brown’s monthly press conference, held yesterday, was dominated by the issue. The Prime Minister was forced to deny claims that the NHS was being privatised or that practices would close. He said "The issue is about increasing access to primary care, not replacing the existing GPs. We want GPs to open longer hours and we want them to open at weekends and if that is not possible in some cases we want to provide other sources of medical care."

For anyone confused about the polyclinic row, there is a very helpful ‘big question’ piece in the Independent, alongside Jeremy Laurence’s article. It explains the different types of polyclinic models, which are not widely understood. Perhaps the most helpful answer is in response to the question, ‘why do the government and doctors disagree?’

‘It is hard to say, because both sides keep shifting their ground. The BMA says polyclinics will mean patients have to travel further and undermine the personal relationship between patient and family doctor. Yet health centres containing a similar number of GPs have been part of the medical landscape for at least 30 years. The Government says polyclinics will be more convenient for patients, offering longer opening hours (8am to 8pm), and more services so they won't have to travel to hospital for tests and treatment. But despite ministerial denials of any diktat from the centre about their number, funding arrangements imply that every primary care trust must have at least one polyclinic or risk losing cash’.

As expressed, the grounds for disagreement are not that strong - the central issue is of course, power.
Another interesting question in the Independent’s Q&A is ‘who is to blame for this debacle?’ The answer is very fair.

‘The BMA bears a share of responsibility for its stubborn refusal to accept that there is anything wrong with general practice. While patients express themselves largely satisfied with what goes on in the consulting room, there is greater concern over what happens front of house – with access, appointments, and getting through on the phone. But ministers, too, must carry the can for failing to spell out their plans clearly and for ramping up the temperature of the debate with the profession. Now that polyclinics in London have got the go-ahead, a bout of bridge building is urgently needed between the two sides.’

NHS workers in UNITE reject pay deal

It is not only the doctors who are unhappy with the government. The Guardian reports that UNITE have rejected the three-year pay deal on offer and have also voted to ballot for strike action.
UNITE now joins the GMB and Royal College of Midwives in rejecting the deal. The unions are not united on this issue - Unison and the Royal College of Nursing have already backed the offer for English NHS staff.

‘In the Unite ballot of 75,000 people, 94.8% of health sector workers, such as health visitors, hospital pharmacists and hospital chaplains, voted against the pay deal. It follows a separate ballot last month in which 12,000 ambulance workers and ancillary staff belonging to Unite also rejected the pay deal.’

A date for the ballot on strike action has not yet been set.

Co-payments – the momentum for a fundamental debate about what the NHS provides continues

Writing on Onmedica, Martin Rathfelder adds his perspective on the ‘top-up’/’co payment’ debate. Should NHS patients be able to pay out of pocket for expensive drugs that are not provided by the NHS and continue to receive NHS treatment? His perspective is interesting as he is the Director of the Socialist Health Association. Perhaps, surprisingly, he believes that people should be able to pay for aspects of their care if they so wish and should not be excluded from the NHS.

‘Even oncologists tell patients they can try any alternative therapy they like. GPs do not turn children away when they have been treated privately with Calpol, or refuse treatment to people who use herbal medicine. We don't deny free music lessons to children who have private music tuition.’

He makes the point that the ban on people getting NHS treatment ‘only seems in practice to apply to privately funded chemotherapy’. He believes that ‘a public discussion about the nature of the commitment to a comprehensive health service is timely’. His view is that ‘we can hardly refuse them permission to spend any money’ if they so wish and that ‘the essence of a comprehensive universal system is that is available to everyone, no matter what they do'.