Sixty years ago, the medical profession took on Nye Bevan and lost - are we about to do the same thing again?
The circumstances look incredibly similar. Mr Bevan proposed a grand new scheme to improve access to healthcare. The British Medical Association put everything in his way. The health minister appealed directly to the public and over 80 per cent signed up. He approached a leading clinician, Lord Moran, and won him over as well. The BMA then ran a second ballot, which was foolish because the result could not have been more decisive than the first. The ballot showed that 40 per cent of doctors had caved in. The rest is history.
Now the government has proposed extended opening hours for general practice. GPs have been balloted and are overwhelmingly against it. Lord Darzi has been appointed as a health minister and has come up with proposals that will not only extend hours but change the way care is delivered. The public are very much in favour of improved access but appear unsure about Darzi "polyclinics".
The BMA is throwing everything at persuading people that these clinics are terrible, but it is not at all clear that they are winning. There are signs of cracks. Some GPs have signed up for the access directed enhanced service, and there will be many applicants for the 100 new general practices and 150 extended access clinics.
Getting on board
I have no idea who will win. I do know there is a lot for us to lose. I see problems with the proposals but none that cannot be resolved through negotiation. I am not at all sure why we are fighting. What is so difficult about extended hours as long as we ensure they do not mean longer working hours? In London, my practices open Saturday mornings from 9 am to midday. The doctor who works it is given a half day off in lieu. I do my share in the rota. There are no interruptions. It is possible to work to time and there is no additional admin. Frankly, it is a haven of sanity in an otherwise mad working week.
Skill mix seems to me not only essential but highly attractive. What pleasure is there in seeing 20 or 30 upper respiratory tract patients a week or handing out sick notes? I have documented more than 1,000 cases triaged by prescribing nurses. Over half are dealt with on the phone and less than a quarter need to see a doctor. I see the cases I am trained to see.
Just because the government's ideas come from a surgeon politician does not make them wrong. There is nothing more radical in these ideas than there was in the development of the out-of-hours co-op. The only difference is that we are not in the driving seat and therefore not defining the service and the resource requirements. In my view, it is time we did both. We can beat the politicians, but we take the public on at our peril.