The rules are always changing…
In a letter to The Times Dr Mark Porter, former head of the BMA opines on Fund Holding and his own practices approach. Doctors awarding contracts to their own companies was predictable 25 years ago, a former BMA Chairman says:
I for one am not surprised by your headline “GPs award £2.4 billion to their own companies”. It was predictable 25 years ago. Andrew Lansley’s “commissioning groups” are descendants of Kenneth Clarke’s “fundholding (FH) (general) practices”, part of his so-called reforms of 1989-90. They were essential to the plan to undo Sir Keith Joseph’s integration of Aneurin Bevan’s tripartite health service, replacing co-operation between parts of it with competition, through an unknown, untried, and untested “internal market”. Those practices were given money to spend as they thought fit, without regard for the rest of the service. The practice I was in, which met all the criteria for fundholding, declined to apply because we did not wish to put the possibility of personal profit before the good of the service as a whole.
Sadly, we cannot put the clock back, but I am not hopeful for the future of what I believe was the greatest advance in healthcare provision in history.
Dr John Marks
Chairman of BMA 1984-90
Well, I was in a FH practice. We discussed the ethics at practice meetings. The first duty of a doctor is to “put his patient at the centre of his concern”. That is NOT to the community or the population as a whole. That is the duty of politicians and government. Under the rules at the time, our patients would lose out if we failed to become FH, and they were given choices not available today. By using waiting list initiative monies efficiently, in one year we eliminated patients waiting, provided they were willing to travel away. The rules were meant to allow budget savings to be returned to practices. In decisions that were never tested in law (it could have been by the BMA) Mr Blair took savings back into the government coffers by retrospectively taking both audited and unaudited savings.. No wonder the GPs who remain are untrusting – but they remain pragmatic. Some of the FH GPs went on to commission as they had developed an interest in management (or a disinterest in clinical care?) and they must find it very difficult to tell their patients the truth about covert rationing which they fail to commission. The ethics of this denial, and the perverse incentive not to put the patient in front of him at the centre of his concern, need also to be explored… Should patients risk being on the list of GP commissioners? (Choice and “Gaming the System” ) Once everyone was FH the system would have failed, or we would have needed to “ration overtly” and honestly..