General Practice in England is in a state of crisis that has been gradually engineered since 1990 when measures to convert the NHS to a profit-driven, private health insurance system were first introduced. Since 2010, we’ve seen deliberate defunding, preceded by contract changes in 2004 which have increased fragmentation and market bureaucracy, making a greater proportion of practice income conditional on target driven outcomes, often without clear evidence of any benefit to patients (such as dementia screening and over 40s health checks). Simultaneously, hospital services have been cut in the face of growing demand (the number of NHS hospital beds has been halved since privatisation), shifting unmet demand into the community without additional resources.
The inevitable result is that practices face serious challenges of low morale, poor recruitment and retention, and burnout. This situation is ideal for the current wave of covert changes which will further mutate traditional British General Practice into a replica of the American-style system with a down-skilled workforce, loss of continuity of care, and the erosion of professional autonomy and patient trust. The latest three pronged attack now underway under cover of Brexit turmoil, is going in for the kill.
Firstly, on February 13th 2019, government passed secondary legislation Statutory Instrument 248 seeking to create new legal entities known as Integrated Care Providers (ICPs). These are based on US Health Maintenance Organisations (HMOs – origin explained in ‘Sicko’ film by Michael Moore) which have restricted ‘capitated’ budgets and built-in incentives to generate surpluses and profit through the denial of care to patients.
By signing up to Networks, GPs will be unwittingly assisting their own ultimate demise and abdicating autonomy and patient advocacy. Corporate bottom line will be the master not the patients best interest.
Secondly, GPs are currently being encouraged to sign parallel contracts forming Primary Care Networks (PCNs) which will be the building blocks of ICPs.
The BMA fully supports this move against the interests of the profession, patients and its own policy statements which oppose privatisation. The deadline for GPs to sign up to PCNs is May 15th 2019, before the Annual Representatives Meeting (ARM). It is unprecedented that a contract change is instigated by the BMA without a vote by the professions representatives at the ARM. PCNs and their new funding streams will be used to replace doctors as the point of access to primary care with autonomous non-doctor substitutes progressing the down-skilling agenda which is necessary for profit maximisation. This dilution of staff experience and qualifications will inevitably lead to worse care and avoidable harm to patients. Incentives are built in to PCNs to deny care to patients to reap financial reward from a ‘Shared Saving Scheme’ which is the cornerstone of American system of HMOs. The NHS owes much of its strength and cost-effectiveness to the robust GP and Primary Care system which PCNs will dismantle. Continuity of care, the doctor-patient relationship and trust will all be sacrificed in mutating of Primary Care to maximise profits. In due course, PCNs and ICPs will be available for private corporate takeover as there is no specific and legally binding commitment for them to remain as public bodies.
Thirdly, primary legislation is being sought to repeal Section 75 of the Health and Social Care Act 2012 (HASCA). This is being presented by CEO of NHS
England, Simon Stevens, (ex-President for Global Expansion of American health insurance giant UnitedHealth) as reversing privatisation by removing the need for open competitive tendering. This manoeuvre
is in reality designed to facilitate private sector monopoly or oligopoly within the NHS and to avoid public scrutiny. Section 75 is an obstacle to the creation of ICPs and it is for this reason that Simon Stevens is promoting its removal.
By signing up to Networks, GPs will be unwittingly assisting their own ultimate demise and abdicating autonomy and patient advocacy. Profit, the bottom line, will be the master not the patients best interest. BREXIT has been perfect cover for the transfer of our NHS to corporate raiders.
#SickoUK
#NoGPNetwoks
https://commonsvotes.digiminster.com/Divisions/Details/637
The Truth About HMOs – Sicko
https://www.youtube.com/watch?v=nDHklw6PV3U
