Capitalism, Inequality and Our Health

by GP sector Tue Apr 17, 2012 20:41

GP's as part of the NHS run their surgeries as self employed Independent Contractors to the NHS and have done so since its inception in 1948.

GP's gained the Parliamentary Concession A9 that enabled them to remain self employed but still enjoy the benefit of joining one of the best Pension schemes available to anyone in the UK today.

GP's can purchase the building they work out of and so own it - which is a substantial piece of real estate. But unlike any other business in the UK (or the world probably) they are eligible for a special "grant" that pays the cost of their purchasing the surgery building under the "Cost Rent" and/or "Notional Rent" schemes.

Under the new Contracts introduced in 2004 - nGMS and PMS, GP's enjoy a significant increase in pay for significantly less responsibility. In particular the OOH (Out Of Hours) cover nights and Weekends simply fell away for GP's such that many areas now have to employ expensive Locum facilities which often include flying in Dr's from other parts of Europe at ridiculous cost.

So in my view - Primary Care in the NHS has been "privitised" for years and for GP's to state that they do not want OTHER providers competing with them is simply protectionism.

The NHS needs to get real. It is wasteful and needs a revamp. It was designed in the 1940's and is still stuck in the those mid twentieth century decades.

You only have to read the reports on how our elderly are treated to realise change is needed.

What we do not need is those with their snouts in the NHS trough bleating about how nothing should change because those of us who actually KNOW what the NHS is and how some within it are self-serving "fat cats" themselves, are fed up with the spin and the lies.

by scummond baiter Tue Apr 17, 2012 22:48

good article - greedy capitalist scum fuck off out of our NHS!

by Des Wed Apr 18, 2012 07:55

Good to see you can follow up an interesting comment that made me think about the situation (are GP's really self employed? - if we subsidise their purchase of their premises why does the NHS not own the surgery in the end?) in such an intelligent and reasoned manner.

We need intelligent debate - not gutter language.

Remember - Rudeness and arrogance are the training wheals on the bicycle of life - used only by those whose personalities are so flawed that they cannot achieve a balance in life.

by CHe Wed Apr 18, 2012 12:30

NO filthy uncaring profit-taking capitalist principles in the NHS - EVER!

by to the first commenter Thu Apr 19, 2012 15:36

if you bothered to actually look into what's happened with the NHS you would REALISE that there has been efficiency savings of £8 BILLION recently, so jog on when you say that it's outdated and needs a revamp.

cancer screening turnaround times have been halved. more improvements can be made, and will, so you can stop trotting out all the old lines, mate. It's getting tiring rebutting them all the time.

by NHS worker Thu Apr 19, 2012 20:30

I am getting tired of seeing the inefficiency hidden behind statistics.

I am getting tired of seeing filthy wards that never check for C.dif because if they do not check for it they can state that none has been found.

The latest independent reports on how the elderly are treated is in many ways the tip of the iceberg.

The NHS should be looked at. The status quo suits those that do not want change. Yes change is happening and that is overdue. The scrapping of the PCT's is a good thing but I have serious doubt that GP's should be given a free reign over how secondary care is sourced.

If the NHS is to survive - it has to change.

Those people within it often recognise this - I am one of them.

The ridiculous bandwagon jumping of the anti anything and everything to do with change need to sod off and get real.

It is not about Capitalism - it is about patients and value for money.

by J Fri Apr 20, 2012 16:09

I too work within the NHS. I disagree with what you're saying. All I agree with is that there's always room for improvements!! Of course elderly care can be improved. But do you REALLY think that this health bill will provide the means for this improvisation?

Since when has privatisation ever been good for anything? Public transport? Gas?

So, at certain times they haven't checked for C. diff? That is a very vague statement. How can you qualify this? And do you think that improvements can be made within the micro lab without outsourcing the work, whilst creating a two tier system and making profits from illness?

What I can tell you, is that £8 billion has been saved SO FAR
heart disease mortality reduced by half over 10 years
better access to dentistry
cancer screening result turnaround times reduced by a HALF

We are getting better all the time, even with less budget and less staff. You wouldn't dare come into my lab and tell us we're inefficient, and you wouldn't be able to. pure and simple.

by J Fri Apr 20, 2012 16:13

why is the scrapping of PCSAs a good thing? I agree that GPs shouldn't have a free reign.

do you realise that 80% of the lords have shares (vested interests) in healthcare companies?

I am curious as to your job. And if you see that work isn't being carried out correctly YOU have a legal obligation to report it, mate. I would. Maybe that's why improvments aren't being made? ffs

by J Fri Apr 20, 2012 16:15

Looking at your post again, it seems full of tory soundbites.

We can have value for money already if we want. And we can also give patients choice as well. There's no reason to say we can, there is NO REASON as to why certain areas have to be outsourced. It's privatisation, back door. Nuff said.

by @ J Sat Apr 21, 2012 07:13

I do work in the NHS and I also have elderly relatives that have faired very badly. Two have been discharged with C.dif and in both cases the GP concerned complained because the individual was discharged into a sheltered housing warden assisted flat with the prospect of a C.dif outbreak in the community.

The Hospitals in both cases did nothing. I myself checked the C.dif status and found out how the Hospital was hiding the true state of their wards. Clostridium difficile is so named because it is difficult to detect.

It is impossible to detect if you do not do the specific tests.

As for the improvement in NHS dentistry! - are you having a laugh? - Before the numpties in the NHS tried to bully the dentists mny years ago, NHS Dentistry was the norm. Then typcal NHS management stupidity took over and the dentists walked away from the NHS en masse.

As for the PCT's these were a burdon on Primary Care because they were simply a paper chase extra level of administrators between the GP (Primary Care)and the Hospitals (Secondary Care). What finnished them off was their voting to increase THEIR budget whilst cutting everything else.

nGMS was a disaster for the public.

OOH's is just the tip of the iceberg.

As I say the only people who do NOT want change in the NHS are those that do not understand the bigger issues and fear for their well paid and very well pensioned jobs and those even further up the pecking order with their snouts in the trough.

And on a specific point re your post - how fucking typical that you accuse me of having Tory sympathies! I do not - far from it. It was Labour who screwed up Primary Care in 2004 and it DOES need a re-think. PCT's had to go - the public had twigged that you had administrators dictating to GP's what treatments they could Rx. The issue with Commissioning is that GP's are hardly the best people to be put in charge of money given the experience we have seen re their Global Sums under nGMS.

You need to grow up J and realise that just because someone has differing views to you on something does not mean you can dismiss what they say by labelling them something that they are not, never have been and never will be.

Arrogance and ignorance are often easy partners in the minds of those with a vested interest.

by prospectus Sat Apr 21, 2012 13:27

Fuck off Hammond, you are still nothing but a fukkwit moron!

by J Sun Apr 22, 2012 13:23

No, I didn't accuse you of being a Tory, what you have written is full of the typical soundbites of a Tory gvt.

And because of your two, personal experiences you're going to say that the new Health and Social care bill is a good thing? Blimey, I've had a negative experience within the NHS myself but I am also grown up enough to realise that this STILL would and does occur within a privatised setting. This is NO reason to completely change the system we have now, more of a reason to improve it.

You think that BUPA hospitals are any better, really? There have been recent studies which show due to the larger proportion of international patients within private hospitals the types of 'superbugs' typically seen are of a greater variety than those in NHS hospitals and generally require different antibiotics than those in the UK in order to deal with them. This is more dangerous, and actually adds to the problem of creating superbugs in the first place!

How do you think our healthcare will look in ten years time? Will it be slightly privatised? Or massively so?

I believe we are heading onto the American pathway, and that is a massive shame. We can improve what we have without interference from private companies who's sole basis is to make money.

Studies have also shown that looking after every person in the country adds benefit to even the richest in society. So it's in everyones interest to have the access to a free at point of use healthcare system. We need to protect the idea we have at the moment and this bill is a bastardisation.

by J Sun Apr 22, 2012 13:31

My issue is privatisation, your issue sounds like inefficiency.

Question: Can the NHS be improved without private companies?

I believe the answer is YES, and I also admit that there is work to be done, no denying that. If you can explain to me how privatisation would help, that would be great.

by NHS Worker Sun Apr 22, 2012 18:26

GP's are already self employed and my point was that as the NHS has used them as Independent Contractors to the NHS since its inception in 1948 it hardly seems realistic to say that the NHS should not use other "Independent Contractors" as well as GP's!

So -you may not be aware - but Primary Care has been "privatised" since 1948!

As for whom these Independent Contractors for Secondary Care will be - that will depend upon who gets to decide and may well be the new Commissioning Groups and this needs to be for the benefit of the PATIENT! - Until their welcome demise - the running of Primary Care was run for the benefit of the PCT's in my view. Arse about face sums it up very well.

My concern is that some GP's could not run a proverbial in a brewery - that is not a negative aimed at the GP - because some GP's are excellent at treating patients and were as pissed of as anyone at having their clinical judgement overruled by a non medically qualified administrator in the PCT's! - But a good GP may not be a good manager of a huge budget.

So the be a success the GP's must be in overall charge but they will need some administrative help.

There are far far too many people with a vested interest in the old boys network that want nothing to change because they have THAT vested interest! This is wrapped up in political hype and spin and blames the "Free Market" for all sorts of ills and failures within a market that is NOT free!

I think it is right that Primary Care SHOULD be able to choose and select where patients go for Secondary Care. I think it wrong that a Patient should only have the choice of Hospital "A" because some administrator dictates that that is the only option.

I want the patient and GP to be able to select a) the treatment and b) the centre.

If this means the patient uses a Private Provider or even the services of another country, (France offers better care at lower cost on many procedures) because it suits the GP and the patient better then so what? - Who ever said that the NHS was set up to provide secure jobs and fantastic pensions for its employees? - I thought it was set up for the benefit of the patient.

One bit of really stupid legislation born of the politics of envy was the Labour Governments removal of tax relief on Private Medical Insurance for pensioners. This was done for pure political reasons and if it had not been removed, many elderly people would now be claiming on their private plans for their health care for a very modest cost to the tax payer. Instead they are all having to rely on the NHS and the NHS struggles.

The real issues of Hospital derived infections is down to the relying on antibiotics to cover up for bad care. If barrier nursing was still in evidence then Hospital born infections would not be so prevalent.

The BUPA comment is worthless - BUPA is a provider for those who have a PMI policy.

What we are looking at now is a way of sourcing care for the NHS at better value. They may have a place - but they may not.

I am not a Tory - never have been - but I am appalled at the shocking self interest wrapped up as a false moral crusade.

by media tart Mon Apr 23, 2012 19:03

whenever tories or capitalists get their greedy grubby hands on any national asset in any country they plunder it to death for two reasons ~ one because they hate the merest whiff of 'socialism' anything ~ two because they are anti-social money-grabbing scum

by NHS worker Mon Apr 23, 2012 20:14

Yes - thank you - a really inteligent and well thought out response to the reall issue.

When I want yesterdays tired old slogans I will read the graffeti

You need to get up to speed and realise it is NOT about Capitalism - it is about the NHS and where it goes from here.

What I do not see is ANYONE responding to the fact that Primary Care has been in the hands of Independent Contractors to the NHS since inception in 1948!

So why not roll that out to other providers further up the chain?

Or is this fact not one you want to admit too and so you feel it best just to ignore it and hope it goes away?

Like I say - what I see is vested interest wrapped up in a false moral crusade. Sickening

by CH Mon Apr 23, 2012 20:15

The graphic on the article says it all innit!

by Mary S Mon Apr 23, 2012 21:36

I don't believe for one second that you work within the NHS!

I do, and of the hundreds of NHS workers I've had the privelege to work with over my career every single one of them cared about the people in their care, whereas you clearly do not.

You sound just like another petty conservative to me, or a shareholder in BUPA maybe.

by NHS worker Tue Apr 24, 2012 06:16

Well Mary S – I do and no stupid accusations from you will change that.

As for patient care – read this and then see if your arrogance is justified

http://patients-association.com/default.aspx?tabid=80&Id=23

And as I say – given that GP’s are self employed Independent Contractors to the NHS with a Parliamentary Concession granted to them such that they can be members of the NHSPS and they have the Cost Rent & Notional Rent schemes allowing them to purchase their surgery premises with a huge grant from the taxpayer BUT despite the public purse paying for the building the GP’s then own the building, - can anyone of you apologists for the status quo tell me why, if Primary Care has been in the hands of Independent Contractors since 1948, that Secondary Care could not benefit from that example?

I note with interest that not one person who defends the current system (no doubt because you have a vested interest) has dealt with this point, preferring instead the typical abuse of the individual via ad homs and strawman arguments so typical of the charlatan, too blinded by self interest to see reality.

Mary, your attitude to this reality is like the lack of C.dif testing on the wards in some Hospitals – if you do not look for it – you can convince yourself the problem does not exist.

If the old lady’s buzzer is ignored you can convince yourself that the paperwork you are doing is more important than the thirst of that old lady

If the food is on the tray in front of her – how is it your problem that she is too weak to feed herself?

I was asked by J how I thought “Privatisation” would be better for the NHS. My point is and always has been that as Primary Care is already privatised and has been this way since inception of the NHS, then why cannot Secondary Care?

I want to see GP’s as Independent Contractors to the NHS be the ones in charge of patient care when that care requires referral onto a specialist. Currently the referral choice is limited and used to be dictated by non medically qualified administrators within the PCT’s. They even had the power to refuse cancer treatment if they thought your life was not worth extending by a year or so because whilst they voted to increase THEIR budget, the treatment budget was reduced.

To have a loved one have treatment refused based NOT upon any sort of duty of care but because their post code – where they lived – meant that the PCT in question had made an admin decision not to treat despite the recommendation of the GP and Specialist, is an affront to humanity and to someone who has seen this happen from within the NHS it is akin to a chapter out of Orwell’s 1984.

by lols Tue Apr 24, 2012 09:58

youre right Mary he definitely a bupa shareholder petty capitalist type

by . Tue Apr 24, 2012 11:04

Ignore the troll, we all know who he is, he only visits this space to wind up activists, nobody takes anything he says seriously, neither should you.

by Southmead Tue Apr 24, 2012 11:51

Caring and compassion comes first in the hearts and minds of real NHS staff.

by NHS worker Tue Apr 24, 2012 13:43

I have never said that we NHS staff were not dedicated on the whole - but cynical manipulation of contamination reports, as well as concern by all that some sectors of the NHS - particularly elderly care and cancer treatment can leave a lot to be desired.

Sir Terry Pratchett's comment about it being easier and cheaper to get cocaine on the streets of Bristol than treatment for Alzheimer’s is what many of the public take note of - because such comments are true.

Instead ducking the issue - why not try and deal with the reality of GP's being Independent Contractors to the NHS and have been since its inception in 1948. I am not saying this works perfectly, but without the PCT's draining the budget it should work a whole lot better!

That said - when given targets to see patients within 24 hours what did most GP's do? - they forced patients to make appointments that day and refused to make appointments in advance.

Therefore targets made!

Money earned!

Patients put to considerable inconvenience.

If you have a vested interest that pays well then little reason to welcome change.

by duh Tue Apr 24, 2012 14:54

newsflash for you "NHS worker" - there is much, much more to the NHS than GPs duh

by CHumpwatch Tue Apr 24, 2012 15:08

The last time those fukkin tories were in power under Thatcher they part-privatised the NHS, almost immediately hygeine standards declined and hospitals had major problems with mega-infections, a lot of people died, and still they still do today, yeah those stupid fukkwit tory capitalists made a killing alright, same old same old greedy bullshit here now.

by Lovatt Tue Apr 24, 2012 16:36

Everybody knows that conservatives do not care about anybody but their arrogant small-minded selves (and their bank balances) they are not to be trusted with any national asset, especially not our NHS

by Allison Green Tue Apr 24, 2012 17:56

The concept of profit on Health-Care needs medical attention, as do its proponents - although in my opinion, they need psychiatric attention.

by NHS Wed Apr 25, 2012 08:26

Is that the answer is it? the ideology of the soviet Union - If you do not agree with us then you need psychiatric care. As for what ANY political party did to the NHS - you will find that it was Labour in power in 2004 when nGMS and PMS contracts were introduced that allowed GP's to give up OOH's such that we now have to "import" foriegn Dr's for OOH cover at weekends, whilst increasing GP's earnings by circa 20%. Oh and if SOMEONE could deal with the REAL issue I raise? - that GP's have been self employed Independent Contractors to the NHS since inception and so why would similar be so terrible for Secondary Care? that would be nice. Bu if you simply want to rant about Capitalism and suggest others that disagree with you require psychiatric treatment then do not expect many people to take you seriously. Your vested interest is showing through too clearly.

by Real NHS Thu Apr 26, 2012 22:47

Every day, researcher Éoin Clarke runs a check on the number of parts of the NHS that have been 'carved up and offered to privateers that day.

The sad news is that the NHS sell off is indeed accelerating.'

Clarke has identified 81 NHS contracts worth a total of more than £2 billion that are set to be privatised, or have recently been so.

He adds that there are over 2,300 'chunks of the NHS that private companies can now bid for.'

Amazingly, 'cuddly' Richard Branson's Virgin now controls 18 NHS contracts across 15 English counties.

Andrew Robertson, founder of the blog Social Investigations, observes that more than one in four Conservative peers - 62 out of the total of 216 - and many other members of the House of Lords 'have a direct financial interest in the radical re-shaping of the NHS in England' that has just been implemented.

These unelected peers - with personal interests in insurance companies, private healthcare and private equity groups – were able to help push through a bill from which they will now profit.

If they had been elected local councillors, such personal interests would have debarred them from voting.

Consider just one example: Lord Waldegrave, who was Secretary of State for Health from 1990-1992.

He is an adviser to UBS Investment Bank whose healthcare division has earned the firm over $1 billion since 2005.

He has a poor voting record in the House - less than 8 per cent of votes in his time there - but he did manage to vote on the Health and Social Care Bill.

He is Director of Biotech Growth Trust plc which is managed by Orbimed, the world's largest healthcare-dedicated investment firm, with approximately $5 billion in assets under management.

Robertson rightly points to 'the network of vested interests that runs between Parliament and the private healthcare industry.

This cosy, toxic relationship,' he warns, 'threatens not only the future of the NHS but that of democracy in the UK.'

He adds:

'the companies who have lobbied for the NHS to be privatised have taken one giant leap into its eventual dismantling.'

Although clearly a scandal, it is no surprise that:

'Our politicians sit on the boards, they own the companies, they are the directors.

They are meant to be public servants, yet the evidence points towards them serving another element of society, one that is hidden behind corporate confidentiality and "Chatham House" rules.'

Along with the NHS, the BBC is supposed to epitomise the best of British institutions.

The BBC has a duty, enshrined in its Charter, to report objectively on stories of national and international interest.

The NHS affects every man, woman and child in the country.

And yet we suspect very few members of the public realise what has just happened to their health care system.

The BBC mostly failed to cover the story, and otherwise offered coverage heavily biased in favour of the government’s perspective.

On the very day the bill passed into law, the tag line across the bottom of BBC news broadcasts said ‘Bill which gives power to GPs passes’.

The assessment could have come from a government press release, spin that has been rejected by an overwhelming majority of GPs.

The BBC has also repeatedly failed to cover public protests, including one outside the Department of Health which stopped the traffic in Whitehall for an hour.

It is nigh-on impossible for Media Lens, with our meagre resources, to closely monitor the prodigious output of BBC television and radio news; even on a single topic.

But one activist who has been following the NHS story closely over an extended period sent us this last month:

‘For the past two years there has been so little coverage of this bill that even as some were desperately fighting to stop it - through e-petitions, lobbying campaigns and even demonstrations - many people did not appear to be even aware of it.

I have been on a demonstration in which people sat down in the road in Whitehall, outside the Department of Health and blocked the traffic, yet this was not mentioned at all on the news.

‘When the BBC have reported on the bill they have been sparse with their explanations of its implications or the reasons why so many - including most medical professionals - have objected to it.

They have tended to limit their comments to those of the type “Some people say it's privatisation” without explaining why or exploring the issue.

‘There have not been - as we might have expected for so momentous a change - debates on the Today Programme, on BBC Newsnight, or blackground analysis programmes, with politicians being challenged and questioned on the policy.

Radio 4 ran a programme at 8pm [The Report, on March 22, 2012] which appeared to be very biased in favour of the bill, with opposing views not adequately represented.

Contrast this programme with this article by Hackney Keep Our NHS Public (KONP)

‘Whatever one's views on the Health and Social Care bill, surely such large scale changes which may affect the health of so many, should have been widely reported and debated, especially when you consider that the coalition government was not elected and did not put this issue in their manifestos.’

by NHS Worker Fri Apr 27, 2012 08:10

Breaking Through How GP-Led Consortia Can Unlock The Full Potential Of The NHS
Main Category: Primary Care / General Practice

Dr Michael Dixon, chairman of the NHS Alliance, called on the Government to speed up the process of NHS reform in areas where GP-led consortia are ready, willing and able to get on with the job of improving services for patients.

The Alliance will today publish Making It Better, a paper explaining how GP-led consortia can unlock the full potential of the NHS.

The paper includes six case studies showing what consortia are doing already to improve outcomes for patients and increase the productivity of the NHS. The studies demonstrate how patients will benefit when the consortia take over responsibility for commissioning on a much bigger scale.

The paper sets out 10 good reasons why GPs are well placed to make decisions about how local healthcare services should be organised.

Dr Dixon said: "We are hearing a lot about delay in reforming the NHS. But delay in the parliamentary progress of the Health and Social Care Bill need not mean delay on the ground. Across England, there are dozens of GP-led consortia that are ready, willing and able to take increasing responsibility for commissioning NHS services for their patients. They have broken through the credibility barrier that has held back clinically led commissioning for too many years. Their enthusiasm must not be wasted.

"We don't want to impose change on areas where the consortia are not yet ready. But if the whole convoy waits for the slowest ship, we will all be sunk."

Dr Dixon called on Sir David Nicholson, chief executive of the NHS in England, to issue guidance to Primary Care Trusts to allow pathfinder consortia that are ready, willing and able to take on commissioning responsibility as soon as possible. Dr Dixon said: "We are raring to go. If the NHS is to deliver greater efficiency, better health outcomes and more patient satisfaction, we have no time to lose."

10 good reasons

Below is a summary of the 10 good reasons for giving GP-led consortia responsibility for commissioning.

1. GPs know the patients and the routes along which patients are directed as they move through different hospital departments towards discharge, rehabilitation and aftercare.

2. Their knowledge puts GPs in a position to innovate and improve the service. They know when patients have to go to hospital for care that could perfectly well be organised nearer home, or even in the home.

3. Doctors, nurses and others working in general practice are used to acting as advocates for individual patients, but they are also in the ideal place to be advocates for the population as a whole.

4. GPs are qualified by years of professional training to talk to hospital consultants on more or less equal terms. They are much better equipped than PCT managers to understand the risks of alternative courses of action.

5. Perhaps even more crucially, GPs can talk to other GPs on equal terms. When GPs are in charge, other GPs are more likely to investigate why they might be spending more than average on drugs or referrals to hospital.

6. GPs are part of a primary care team, including practice managers, nurses, therapists, pharmacists and receptionists. They are better placed than anyone to know if people are falling into the cracks between health, social care and the charitable sector.

7. Doctors are trusted. The latest opinion poll results showed 92% of British adults said they would trust doctors to tell the truth - a much higher score than for other professions.

8. Since the foundation of the NHS in 1948, most GPs have been independent contractors who were responsible for running the business side of their practices. Many GPs are well used to working in partnership with managers.

9. Only a small fraction of the cost to the NHS of running a GP practice goes to the GPs for salaries and overheads. The big money is spent on what the GPs decide to do for their patients, including referrals to hospital, diagnostic tests and prescription costs. It is not good enough to leave the GPs as providers with every incentive to increase their own income, but no incentive to make best value of the NHS's overall investment.

10. GP commissioning is now the best hope for the health service. It can be seen as the third way. It avoids the mistakes of bureaucratic state control on the one side and the anarchy of market competition on the other. For that to work, GPs will need to extend their role from looking after each patient in front of them to also being responsible for improving the health and services for all local people.

-------------------------

The fact that 8) above is proof that having Independent Contractors providing service actually WORKS! - and has done since 1948 means that if all you have is name calling as a "defence" for your own vested interest then you will get nowhere.

STILL - no one on here is able to say anything at all about why using Independent Contractors in Secondary Care, following the example of what has actually been happening in Primary care since 1948 would be a bad thing for Secondary Care!

All we get is silly name calling!

by Real NHS Sat Apr 28, 2012 13:01

May Day March against the destruction of the NHS!

Organised with the Bristol & District Anti Cuts Alliance with union support.

Gather from 11am on college green, the march will head through town to castle park.