In our constituencies there are shocking health inequalities and disparity in access to primary care, but it is nearly impossible for GPs to set up new clinics. Following the free school policy could change this, say David Burrowes and Nick de Bois
In less than four years the Conservative led government has undertaken more radical reforms than Labour managed its previous 13 years. Despite enjoying large majorities in Parliament, Labour made the easy choice to spend more money but ducked the difficult decisions about reform.
‘We are not coming to this issue as MPs wanting to have an ideological rant or to simply fly a policy kite’
On education and welfare in particular, the Conservatives under David Cameron have had the courage to do in a coalition what Tony Blair didn’t have the principles and bottle to do even after a landslide victory.
At the heart of our education reforms have been free schools. Allowing teachers, parents or the voluntary and private sector to set up new schools outside of state control has been a success, and one rooted in Conservative principles too. Central to the thinking is that free schools should be allowed to set up anywhere, not just where there is a lack of school places, because driving up standards is equally important.
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Guaranteeing a child a school place is not enough if the only school on offer is failing. Free schools are there to break up the state monopoly and offer real choice. Freedom has the answer and the result is greater provision and higher standards.
It is therefore frustrating that we cannot apply the same principles to another area of public policy that is just as important: GP services. Here we desperately need greater provision and higher standards and yet we’re maintaining a state monopoly that is not in the best interests of patients.
Disparity in access
We are not coming to this issue as MPs wanting to have an ideological rant or to simply fly a policy kite. Our concern is very practical and local. In Enfield we have a problem that is no doubt shared across the UK in terms of a lack of quality primary care.
‘You could walk from one end of our constituencies to the other and life expectancy would reduce by about 12 years’
However, Enfield has been one of the areas which has implemented a radical reconfiguration of hospital services and has been the subject of intense reviews and scrutiny. While there has been opposition about the removal of accident and emergency services at one of our local hospitals, there has been unity about the need to significantly improve and expand primary and public health.
There has been a big increase in funding under this government but we have a legacy of shocking health disparity across our borough. You could walk from one end of our constituencies to the other and life expectancy would reduce by about 12 years. Disparity in access to a GP and other services is also marked. In one part of Enfield the quality of GP provision is particularly poor.
A recent Care Quality Commission inspection described one practice as unfit for purpose; most GP premises are crumbling, unsafe and inaccessible; black and minority ethnic communities particularly are detached from primary care and inevitably end up at A&E.
Barriers facing GPs
Into this barren and bleak health landscape seven years ago an entrepreneurial Turkish doctor bought a derelict pub, gained planning permission for a medical centre and secured over £20 million of investment for a clinic providing extended hours care and innovative primary and diagnostic services unmatched in the area. His project has cross-party support from a Labour council, two Conservative MPs and his local Labour MP.
Patients are overwhelmingly supportive, particularly the growing Turkish speaking community who lack access to primary care. The Doctor even offered to have the first 5,000 patients without rental charge to the NHS in order to prove the better local choice offered. He is still waiting for NHS approval to build the clinic and is now spending money securing the property from squatters rather than opening it up to patients.
Before this sorry tale we did not know that it is not actually possible in the UK to set up a new GP surgery without first spending time working in an existing practice or getting the approval of existing GPs. While this may not be a problem for trainees undertaking their Certificate of Completion of Training – the standard route for entering the profession – it does make for a closed shop for people who have the equivalent training, skills and experience and want to set up a new practice.
Even very experienced GPs who leave and then want to return to the profession must apply to their deaneries, who then identify a practice where they can be mentored before they go back on the General Medical Council’s performers list.
Prevent a catastrophe
If a GP wants to set up a new practice they need to get over numerous obstacles, which ostensibly are based around the needs assessment of a given area and then a competitive bid process. However, underneath is the need to obtain the approval of existing local GPs to the new practice. GPs are often well motivated public servants but let us not forget that they are also private profit making individuals who are disinclined to welcome new competitors. We therefore have GP cartels operating throughout the country making it difficult, if not impossible, for new entrants.
‘Free clinics can do for health what free schools have done for education’
We have a severe problem in England regarding access to GP services. It was crystallised in December by the Royal College of GPs. Looking at NHS data, they found that around 15 per cent of patients in England are having to wait a week or more for an appointment with their GP. That means over 26 million patients who want to see a doctor are waiting a week or more to do so. Not only is this inconvenient and often distressing for patients, it can often lead to patients presenting at A&E instead.
As we look forward to out of hours services and greater innovation providing care previously reserved for hospitals, this situation is not sustainable for the NHS, nor good value for taxpayers. Most importantly it is not the appropriate care for patients.
There are also reports of an impending GP recruitment crisis. The General Practitioners Committee, which represents all NHS GPs in the UK, has warned the effects could be “catastrophic”. A recent survey of 270 practices across the south of England showed 70 per cent had a vacancy to fill in the past year, of which almost one in three was unsuccessful. This is putting immense strain on to clinics, with the workload mounting and GPs struggling to meet patient demand.
Reform is essential
Reform is not just desirable but essential. The reforms needed should follow the ethos of the free schools concept, making it easier for a qualified provider to establish a new GP practice and begin treating patients.
The central pillar of the government’s health reforms was the abolition of faceless, bureaucratic primary care trusts and their replacement with clinical commissioning groups. These groups, mostly consisting of local GPs, are now commissioning health services in their areas.
‘Practitioners could apply directly to NHS England and make the case for setting up a new practice’
The vital supporting pillar of the health reforms was that CCGs can now commission services from “any qualified provider”, whether that be the NHS, private providers or the voluntary sector. With bidders made to compete on the highest quality, not the lowest price, we are allowing commissioners the chance to find the best services for patients – except when it comes to GP services.
To avoid any conflicts of interest, the commissioning of GP services is undertaken by NHS England and not CCGs. However, CCGs have great influence with NHS England in determining what need there is for certain services in their areas. Qualified GPs wanting to establish new practices and access public funding to treat patients are therefore finding it extremely difficult to make headway.
Freedom of choice
Free schools don’t have to apply to the local council to set up, but instead go straight to the Department for Education. If they can demonstrate a need for new school places, based on lack of quality rather than lack of provision, then funding can be released and a new school established. Parents have greater choice and schools compete on quality, driving up standards.
If we follow this thinking, and the natural extension of the any qualified provider concept already established, for GP clinics we could see practitioners applying directly to NHS England and making the case for setting up a new practice. Greater patient choice, higher standards.
The danger of failing to act is that GP provision declines and so too the quality of primary care. The whole of the NHS would benefit from improved access to and quality of GP clinics. Conservative principles, already running through the heart of the government’s reforms, need only be applied further to allow free clinics to do for health what free schools have done for education.
David Burrowes is Conservative MP for Enfield Southgate and Nick de Bois is Conservative MP for Enfield North