"GP commissioning is the bait to privatise the NHS"

This blog has made a point of regularly covering the government's proposed revolution in the NHS. It wasn't even announced pre-election, but now is in serious danger of destabilising the whole organisation - which currently is among the most fair and efficient of international health care systems - and opening the door for private companies to take over whole swathes of the service, making the service less democratic, potentially less fair and, ironically, almost certainly less efficient... something even a Tory MP has recently warned about - not to mentioned almost all of the major organisations representing NHS staff.

In today's Guardian, a GP from David Cameron's own constituency has written a letter condemning the plans, in response to some measured support from it from another GP. It deserves to be circulated wider:

GP commissioning is the bait which Howard Stoate [the chair of Bexley Clinical Cabinet] has swallowed whole. There are good arguments for greater involvement of GPs in designing healthcare pathways, which is why a quarter of us are already nibbling at the idea. But he fails to mention all the accompanying reforms which cleverly reinforce each other to create the conditions for the marketisation of the NHS, with its attendant profit motive and explosion in transaction costs.


No mention is made of abolition of the fixed national tariff for provision of each service. This will lead to a race to the bottom, where competitive tenders will be won by the cheapest bids, as quality is so difficult to measure. The current fixed tariffs ensure competition on quality alone. No mention of Monitor, the body which will ensure awarding of all contracts is subject to European competition law, so preventing GPs from "anti-competitively" supporting their local hospital, if there is an alternative cheaper private provider.

Choice is an illusion to foster the market for competing providers. As a GP, I am uncertain of quality differences between my local hospital consultants, let alone those from multiple providers. Patients stand little chance of making rational choices when outcome data is so easy to manipulate. They always ask for one good local hospital. GPs will inevitably be guided by health management professionals in their commissioning decisions, which the private sector is eager to exploit. Why didn't the white paper just put a few keen GPs in charge of the existing PCTs and save the £3bn being used to create the conditions for an insidious private takeover of our NHS?

Dr Brian Green
GP, Witney, Oxfordshire