The nation’s doctors can be a contrary lot. Some are GPs, others based in hospitals, a few are in public health and others in academia – and there is great variety in their attitudes towards how privatised the NHS should become.
A new poll of doctors, commissioned by the King’s Fund, about Andrew Lansley’s health white paper has produced a predictably mixed bag of views, but it is the most comprehensive insight yet into the reforms, which could carry serious political risks.
Among the 1,000 medics who were polled, almost twice as many do not think the NHS shakeup in England will necessarily improve patient care (40%) as think it will (23%). Improving patient care is the main pretext for the profound changes proposed.
Similarly, 22% say they believe the NHS can make £20bn of savings while undertaking a huge structural reorganisation, but 45% say that it is impossible.
Those two key findings will disappoint the health secretary. He has stressed that doctors – or at least GPs – will be given the key role in the NHS. Under the new policy GPs, rather than primary care trusts, would commission services on behalf of patients.
But family doctors are not yet convinced. Among the 500 GPs surveyed, 41% disagreed or strongly disagreed that the changes would benefit patients, compared with 39% of hospital doctors, while 54% disagreed or strongly disagreed that the NHS could save 20% of its annual budget while redesigning its architecture.
These views matter because, as Nigel Edwards of the NHS Confederation says: “The government’s reforms put GPs in the driving seat of the NHS.
“Their ownership and leadership of the reform process will be essential if the changes are to deliver for patients.”
The survey contains some good news for Lansley, too. For example, 62% of GPs think there are family doctors in their areas who are equipped to take on the new burden of commissioning – though not themselves, necessarily.
About 40% of all medics think the shakeup will prompt GPs and hospital doctors to work together, though the same number disagree.
Interestingly, when asked to identify how the NHS could save money as it seeks to make the required £20bn of savings by 2014, 32% suggested reducing services such as cosmetic surgery, fertility treatment and procedures to tackle obesity.
Cuts, in those and other areas, are already happening, and could spell trouble for ministers. Only 10% of the medics backed reducing staffing levels, though many hospitals are already doing exactly that, through either natural wastage or redundancy.
The Royal College of GPs has welcomed the white paper. But many more key medical organisations, such as the British Medical Association and the King’s Fund, are concerned at the speed and transformative nature of Lansley’s changes.
There is general agreement that empowering family doctors is the right decision, but apprehension that the zeal to remake the NHS so quickly could prove counterproductive.
For all Lansley’s insistence that little in the white paper should have surprised anyone who had followed the Conservative party’s health policy in opposition, its intensely radical intent left most senior doctors reeling. In drawing up the plans he ignored the usual rules of policymaking by not seeking the views of key stakeholders.
Now that doctors and medical organisations are voicing views ranging from confusion to outright opposition, will the health secretary listen and amend his plans? Probably not. Recent history suggests that Lansley is likely to press on regardless.
The Guardian UK