Monday, 19 July 2010


The government’s proposals for commissioning health care have featured heavily in the media and in the blogosphere, and most opinions seem to be very negative. The overriding view seems to be that GP’s will have neither the time nor the inclination to do this directly and will therefore have to employ some private commissioning organisation to do it for them. Such a system will attract those who see the NHS as a business opportunity and these organisations will, like PFI, skim off the top of the NHS budget diverting yet more NHS funds into private hands.

As hospital consultants it seems that wherever this leads we will have to follow, although there is one interesting aspect which I will explore in a subsequent post.

So what can we do if we wish to oppose these proposals. Perhaps the BMA could organise something. In your dreams. The BMA are toothless, ineffectual, irrelevant and worthless. Not even their own members take much notice of their empty posturing. The idea that they might sway government is laughable. In the absence of any credible opposition it has to be accepted that these changes are probably going to happen, like it or not. The government have got the bit between their teeth on this one and it might be better to look at damage limitation rather than total opposition.

I am of the belief that any reasonable system can be made to work as long as those at the helm are people of integrity and intelligence. That we have systems now that increasingly are working badly is a reflection on those we have allowed to run things because the rest of us don’t want to, rather than weaknesses in the system which could have been overcome by better men.

But the best GPs and hospital doctors are primarily, if not exclusively interested in practising medicine, leaving managerial, & administrative roles to their less dedicated colleagues, many of whom have an agenda centred around personal advancement.

The last thing we want or need is to see, when the dust has settled, the same old parasites running the show that we have now, in co-operation with the private sector, simply rebadged and probably with an even bigger salary.

If our jobbing GPs and Consultants express their opposition by turning their back on the process and refusing to get involved the door will be open for the show to be run by those most interested and least suitable and the dire prophesies will become self fulfilling.

That is why those most opposed and disinclined to getting involved, should get involved. It is the only way we might salvage something worthwhile from a potential disaster. You never know, with the right people at the helm we may be able to keep the private sector at arms length and make it work.


  1. I'm not sure I agree. Details are still to emerge but if Polly Toynbee is correct then professionals will npt be able to stop the process of privatisation.
    I'm not sure what you mean by 'at arms length'.

  2. As you admit details are yet to emerge and much of Ms Toynbee's article is speculative. The point I am trying to make is that if we just throw up our hands in despair and refuse to even try and steer the process somewhat, on the basis that it is all going to be a crock of shit, then it will be.

  3. I do agree that those who are not interested or good at clinical medicine can be the ones who act a Quislings. But get people of integrety to engage with this work is a challenge. Those just out to make money are easy to recruit.

  4. There was this funny idea that Foundation Hospitals could be non-profit but no caps profit making hospital. The CEOs of the private companies will have to award themselves a few times PM's salary for their hard work. Many charities pump less than 5% of what people give to real needs.

    You have pointed out in your 2 pieces on Private Practice the problems around a number of Hospital Conultants. So, as far as I can gather, they are doing very well thank you very much. Indeed some are 100% private but with 60% to 75% work coming from GPs via PCTs.

    The future is here as they say.

    Why should anyone want to buy a foundation hospital if it cannot make money?

    Well, there are clever people who used to work for RBS, Northern Rock, HSBC, Citicorp, Goldman, UnitedHealth, Bupa, Priory that can make money especially when the money is from the government, any government.

    GP commissioning will work in some ways if the rules are strict and that means rules barring private sector as they have already our banks.

  5. Oooops, I mean they have already "ruined" our banks.