A couple of days ago Wes Streeting, Labour's shadow health secretary, attacked GPs, saying their finances are murky, in the process obviously seeking to blame them for NHS failings. In the process he threatened to take away the role they have in primary health care.
On Sophy Ridge's show this morning Starmer joined in the attack. I wrote this Twitter thread in response:
I obviously meant joint and not joking in the first tweet.
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You could also say that the means financing the Labour Party is becoming “murky” as the mass membership built up under Corbyn is ebbing away losing millions in member subscriptions and that Starmer and the NEC are now trying to ingratiate themselves with million and billionaires, large corporations and City slickers on the Blair model. This trend will lead even further towards farming out portions of the NHS to a disastrous private health insurance systems like the US which costs twice as much and leaves millions without health care and millions of others with a very poor service indeed.. The whole foundations of the welfare state introduced by Beveridge, Bevan and many others is being criminally undermined.
Thank you for another acute article!
Might this move be an example of straining at a gnat and avoiding a predatory camel?
If so, is this because the Labour Party is locked into Neoliberalism, wishes to please big donors, believes that this is what the citizenry wants or what?
Difficult to put a finger on why Streeting and Starmer usually seem to hit the wrong note. As you say Richard – it’s not the time to appear to be attacking GP’s.
You would have thought they could have come up with something like – ‘we are concerned about groups of GP’s being taken over by US companies, and will work with GP’s to improve their terms and conditions increase their numbers, and especially to break down barriers begtween them, hospitals and patients.
Quite so
It’s all in Nicholas Timmins Book (1995) ‘The 5 Giants: A Biography of the Welfare State’ Andrew.
All Laboured appear to be doing is going back to the spat Bevan had with the GPs and the BMA about how they were to be paid under nationalisation. It nearly cost Bevan his job. It’s as if Stymied has chosen to seek revenge on the GPs for them fighting their corner and being usually from a more affluent background. It’s bringing history alive again to ignore the real problems of today. It’s Fascist class politics we get instead of problem solving and (ooohh!) commitment.
I mean – what else can you do when you’ve got no new ideas or if the new people you’ve got funding you want assurances that you’ll marketize the NHS more?
Some of us were born yesterday. But many of us are not.
Huh.
It’s much easier for these two Laboured weaklings to obviously pick up on a minor historical point than coming up with something new or just getting the problem that got us here in the first place sorted (recent faulty healthcare acts and obvious under funding).
When the NHS was set up, it was the GPs who I understand had to be won over by the creation of the NHS even though according to Nicholas Timmins (‘The Five Giants: A Biography of the Welfare State’ 1995) even the BMA had realised much earlier along with many others that private insurance was not really working (pp. 106-108). But this was a major stumbling point for Bevan.
Apparently according to Timmins, even Attlee had objected to GPs retaining their private practice standing (pp. 111-112) and salaries were discussed back then. The context really is about the state take over of what were businesses – how was it to be done fairly – as well as retaining GP independence in terms of medical decisions ( I can certainly recommend pages 118 to 126 of ‘The Five Giants’ about this titanic struggle – see what you make of it folks). I think a basis for a decent salary plus capitation (payment based on actual patient visits) was proposed for GPs which the BMA regarded at the time as fair and that is what we got (?) – but it was close and like many compromises it left behind mixed feelings.
Certainly with the salaried bit, the worries of some in the BMA and doctors has come to be realised especially in my view since 2010 and Tory austerity. For all I know the Tories have also messed with capitation payments too in their bid to simply destroy the NHS because of ideological reasons.
But what I don’t like about this Richard is that it seems that Stymied & Co are reverting back to a historical struggle between (real) Labour and the BMA/Royal Colleges at the time the NHS was set up. It’s as if they are saying that the problem lies with the GPs – the implication being that they are too expensive. And there is more than a whiff of class politics about this as well given that GPs are more likely to come from affluent backgrounds.
So, instead of getting really concrete and restorative policies for the NHS, we get from Laboured class war over ‘murky payments’ that their predecessors agreed and the raking over of that!! And what is with Laboured? A deal is a deal – people of the Left and progressives don’t go back on deals. Only the Right and Neoliberals play those sort of games.
I’m disgusted that as I suggested, these spineless fools are just going to play in the margins in the context of bad ideas created by the Tories.
In my interests of railways, rugby and other hobbies I’ve got to know a GP or two over the years and given how hard they work to become a doctor, they’re worth every fucking penny they are paid in my opinion. They deal with life and death!!! I’m not interested in their background or class. It’s harder than becoming a blasted MP or councillor that’s for sure who ends up coming out with tripe like Stymied and mannish boy Streeting.
But what’s worse is that it’s Fascism yet again!!! Looking to exploit valid differences, make someone else carry the burden of fault in order to save someone (Stymied) from having to do some real work to sort things out where the problem actually is.
Because in actual fact Laboured now agrees with the Tories and the healthcare market (and all those others who think that the market provides answers) that the NHS is unsustainable.
Shameful.
I’m sure I read somewhere that the only way the Tories allowed the NHS Formation Act to pass was by ceding that all managerial positions would be filled by officers (mostly Army) returning from the war….think General Melchett.
Unfortunately, I can no longer find anything to support this ..Can you help?
I have never heard that
It’s well worth digging out Timmins Andrew – I do not know whether he wrote an updated version.
The Tories were of course mostly against it.
If you were going to be really cynical, you could say that the GPs were bought for their compliance – even though the BMA knew that the health of the nation under personal insurance left a lot to be desired and this was at odds with the aims philosophy of medicine. But this was time in post WWII of new house building, training and jobs with decent pay – all of which has been continuously undermined since the ‘welfare’ state was created. So everyone was being bought to some degree – and why not?
How can you have a philosophy to heal and cause no harm when an ill person cannot pay you to execute your Hippocratic philosophy? Marketisation just turns it into a hypocritical oath doesn’t it? The Neo-liberal answer would be to dump the Hippocratic oath of course.
GPs are just a long line of workers who we are now being told are being over paid apparently! And this goes back years.
Reading Mattei – (The Capital Order – 2022) the destruction of Guilds in post WW1 Britain (pp.95-98) is a story I was totally unaware of, as I was unaware of the Genoa and Brussels conferences in the early 1920’s where the practice of austerity was designed as a curb by finance (government and private) on working class objectives in response to a demand from ordinary people for better living standards.
The BMA is a form of guild and GPs – well, they are working people too – affluent or middle class background or not.
To me it’s just one long continuous war against people of ANY background who actually do a real job as opposed to those who live off their wealth who are always looking for ways to increase the value of their funds by transferring wages out of real work into their bank accounts. Doctors in the public sector seem to be the latest victims.
And to that list of economic miscreants you can add politicians I’m afraid who are nothing but handmaidens for the rich – lily-livered wankers that they are.
Sorry.
And if you think medicine is bad, look at dentistry in this country – it’s all there. The buying and selling of practices, the underpayment of dentists on the NHS side, the obvious wealth in the practice car park of those doing private work (my last NHS dentist came to work on the train!!). But he has left in the NHS dentistry merry go round and now I have to pay for another exam by my next new NHS dentist because she won’t accept someone else’s examination.
General Melchett was the wrong war.
It is certainly foolish if Labour do not value the importance of GPs in provision of healthcare in this country. However the nature of medicine, and expectations of primary care, have changed enormously since 1948 and it does seem reasonable to ask whether the model set up then around single-practitioner GP practices helps or hinders provision seventy-five years later.
My GP practice is in what is labelled a “health centre” but is nothing of the sort. As well as the GP practice the same building has a community sexual health clinic, a mental health community base, a pharmacy, and community physiotherapy, podiatry and other services. But they are completely disjointed. (To be fair, the GP will pass prescriptions straight to the pharmacy to fulfil). It ought to be the case the place is organised to serve the patient rather than the system; for example the best person in the building to assess a musculoskeletal problem will be the physiotherapist (who could easily refer back to the GP if a prescription is required, or the pain appears to have a different origin) but that route is not available to a patient turning up with a problem. And then a mile down the road is something called an Urgent Care Centre which provides further services in a community/primary care setting, but with complicated rules as to what they will look at for fear of stepping on the GP’s toes.
I think if it weren’t for the distortion created by funding mechanisms, most GPs would acknowledge that physiotherapists have more experience and expertise in assessing musculoskeletal problems, mental health nurses in assessing common psychological problems, paediatric nurses in addressing anxieties of new parents, and so on. And the GPs could concentrate on using their own real medical expertise, assessing patient presentations which are more complex and whether they can be managed in primary care by prescribing appropriate medication or whether they need referring to a specialist in secondary care.
It doesn’t take a lot of imagination to think that many of these services could be combined such that a patient would be directed initially to the most appropriate practitioner, all recognised as equally valid health professionals with equivalent contractual relationships (in the case of GPs it would be a consultant contract, which seems to work fine with all other medical specialities). I would certainly be in favour of such a structure being tried out and assessed for both whether it better provides patients’ needs and whether it harnesses public resources well. Even if a pilot was a success it still wouldn’t be a “magic bullet” it would only be suitable to roll out slowly when it became right to reconfigure services (e.g. when local demographics meant significant new investment was needed anyway, or the opportunity arose due to retirement of current staff or need for new premises). It would probably take decades, and never be appropriate in rural settings remote from towns.
I think most GPs would nit agree with you on the issues you note because nothing is a straightforward as you are presuming
I have a GP sitting next to me….
There will be more on this tomorrow
Not saying it would work, just worth trying. Primary care isn’t working properly, and while it may simply be under-resourcing there is a suspicion other health professions could be better utilised in the areas of their expertise.
But on employment, I would have thought it would be difficult to complain about GPs being employed on the same contract as all other doctors with specialist qualifications.
Anyway, I look forward to your further thoughts, and recognise that you hear first hand about the challenge GPs are facing currently.
Thread coming this morning addressing that point and why I disagree with your assumption on employment status
I fear that the Labour Party leadership team is preparing the ground for the takeover of GP services by US multinationals. This is already underway.
The last thing they want is for GPs to be employed directly by the NHS.
The model will be for the Integrated Care Boards to contract with a few firms that will be in an enormously powerful position to have access to data and offer add-on services at a price they dictate.
“Syphon Economics” at its best.
Thanks, as somebody has been a GP for 40 years, I agree entirely with you, Richard. There is a severe shortage of staffing in primary care, and changing the model will not affect that at all. Streeting has no idea what value for money GP partners provide. Unlike salaried doctors, they do not have any boundaries to their workload, they simply have to keep on going until the work is done. Converting them to salaried employees would not take away the work, but it would in all likelihood create a need for a whole new tier of management. Perhaps Wes should look more closely at countries which have a salaried service before expounding on the subject. He is equally ill-informed when he talks about giving patients direct access to specialists. Although the gatekeeper role is not the primary function of GPs, it is one which they exercise effectively, and they are good at ensuring that expensive secondary care services are used to best advantage. Changing the system would simply cause a dramatic increase in waiting lists, as if they’re not bad enough already
I agree with all that
David Byrne writes:
The mechanism being employed to privatise the NHS and the source of today’s problems is the private finance initiative (PFI). Although initiated by the John Major government in the mid-1990’s, this political expedient was eagerly pursued by successive Labour regimes. No wonder that Kier Starmer appears to support the Tory party line.
PFI has been and still is a financial disaster and the direct cause of:
-the fragmentation of service provision
-the closure of hospitals
-privatisation of non-medical internal services with resulting lower wages
-recruitment of non-medical managers, accountants and administrators
-the reduction of 10,000 beds
-the reduction in the number of nurses
-longer waiting lists
-so-called bed blocking.
The list goes on.
One positive step could be the setting up of of a government department to process all PFI future liabilities for payment outside the NHS budget. This would release £ Billions for the provision of better management, medical and care provision.
Whenever I hear or read about Wes Streeting he comes across as a Tory. I’m so disappointed in him and Keir Starmer
Wes Streeting has declared extra earnings /gifts etc. of over £200,000 p.a. And then there’s Starmer a BTL landlord. How can any Labour party member accept any kind of peerage/knighthood – the stench is overpowering.
These are minor issues to me
Getting policy right matters