It’s hard to fathom how stupid the Lib Dem opposition to NHS reform is

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It is really very difficult to fathom how stupid the Liberal Democrats are.

As the Guardian reports:

The Treasury will only support GP-led consortiums if the new bodies have passed rigorous clinical and financial tests, the chancellor's deputy said on Monday.

This happened on the day that the Royal College of General Practitioners submitted a report to the government making it very clear that they, and I suspect the vast majority of their members, are utterly opposed to the whole idea of GP led consortia running the NHS.

So here we have the brightest spark in government, the former PR officer of a national park,  who has no qualification in finance or medicine telling GPs that they must prove their competence in both areas  so that they can do something which they have already announced is utterly foolhardy, and bound to result in the destruction of the NHS, which they seek to preserve.

Now I admit I have some interest in this area as I am married to a GP.  that means, because doctors seem to socialise with each other, but I know quite a lot of  GPs and hospital doctors.  Let me, on the basis of this knowledge, make two suggestions.

Ther first is that GPs are not medically qualified to run the NHS. They are very able people. They've dedicated vast numbers of hours to creating extraordinary skill in primary care.  That means that they are the first port of call for those who wish to make contact with the NHS. But they have chosen, quite deliberately, not to be specialists. Anyone who thinks otherwise is mistaken, including those GPs who like to claim they have a specialism. Their skill is in generalism,  which is, unfortunately, a much underrated area of expertise. As a result, however, they have  relatively little understanding of many areas of secondary care medicine, which is of course hospital-based, or of tertiary care, such as many mental health services. They know how to refer to these services, they know when to refer to these services,, and hopefully they do so appropriately, and effectively. But it does not mean they actually know how those services work, or that they are experts in them. As a result, they are not qualified to make decisions on resource allocation within them. That is glaringly obviously the case.  But it means that they fail first test that Danny Alexander  and the Liberal Democrats have set.

It is much easier to suggest that GPs will fail the second test.  Precisely because GPs have spent so much time developing their clinical expertise they have not dedicated large amounts of their effort to developing  their financial management  skills.  Nor have they needed to do so. Although they are technically self-employed, this is pretty technical. What they actually do is work in organisations that have a budget given to them, which means they have no obligation to  go out and sell, or raise revenue, or worry about cash flow. The so-called businesses they manage expend most of their cash on salaries, property and minor medical disbursements. They are hardly complex enterprises. Outcomes are highly predictable once the budget for income is known. There is no reason why GPs should have skills to  set variable budgets, make decisions on the allocation of resources, when they've never had to do so, or make decisions on investments, financing, or conflicting objectives. This has not been required of them so they will not have that skill set, and I'm delighted they don't: I would much rather they were good GPs.

But what it does mean is that the Lib Dems  are, as now seems to be their pattern, setting themselves up to look stupid. They may, of course, think they are clever in trying to undermine the  Health and Social Care Bill by  making sure the GPs cannot run consortia, but the reality is that if this is the outcome they achieve the Conservatives will simply put these consortia out to private companies. They will have to. Andrew Lansley's illegal action in demanding the creation of  consortia when there was no legal basis for doing so has already am effectively, destroyed the primary care trust structure that has run the NHS in England.  So all the Lib Dems are doing is undermining GPs, looking stupid, alienating the public, and helping the Conservatives privatise the NHS.

Good work Danny Alexander.  I hope the Grampian National Park will have you back as their PR officer when your days in Whitehall are over, soon. But on the basis of this evidence I wouldn't offer you a job

 

 

 


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