The BMJ publishes “Doctors spurn NHS long term plan”, ( BMJ 2019;365:l4392 ) at the Annual Representatives Meeting, which reflects reality. The profession has not bought in to it. It is not founded on a financial or philosophical rock. Without the honest discussion that Mr Stevens called for we can get nowhere. So it’s going to get worse..
Doctors at the BMA’s annual representative meeting have expressed strong doubts about NHS England’s strategy for the next decade, published in January.1
Representatives voted overwhelmingly against a part of a motion proposed by the Wigan division that the meeting, being held in Belfast this week, “welcomes and supports the aims and initiatives of the plan.”
Tom Dolphin, a consultant anaesthetist and member of the BMA Council, proposing the motion, compared the NHS Long Term Plan to a “sketchy unfunded wish list for the NHS.”
He said, “The plan has two major problems: workforce and finances.” He described as “vague” and as lacking identified funding its proposals to shift care from hospitals to the community, to focus more on prevention, and to rely more on digital technology.
“It could have been good, but there’s no detail, too many big reforms, and nowhere near enough money,” he added. “It’s doomed to failure. The government needs to think again.”
A majority of representatives voted in favour of parts of the motion that the plan’s ambitions were largely unachievable because of underfunding and that “the reforms and structural changes proposed are not in the interest of the NHS.”
Without an adequate workforce strategy, the plan would precipitate a greater crisis in this regard, they agreed.
Delegates voted for parts of a different motion that opposed funding cuts imposed through efficiency savings, shifting care from hospitals to the community without a concomitant increase in resources, and the long term plan being a route to a market driven healthcare system.
The motion had been proposed by the retired surgeon Anna Athow, of Enfield and Haringey division, who described the plan as a “business prospectus in code.”
She said, “It is an anti-NHS plan, which is not care according to clinical need but the road to American market driven healthcare.”
But delegates did not agree with part of Athow’s proposal that GP surgeries joining primary care networks could lead to competitive tendering of contracts for integrated care providers. Integrated care systems, she had claimed, would be incentivised to cut care. “These are the principles of the American accountable care system,” she said, which could be run for profit. “The big productivity savings are to come from NHS staff as local ICS workforce boards develop strategies threatening national terms and conditions . . . Skill mix reduction is mandatory, with trained staff replaced with untrained staff.”
George Rae, a GP, was more positive, saying, “In general practice at present we can’t survive without a shift of certain care to other healthcare professionals.” He said that the long term plan did away with aspects of competition and that integrated care organisations needed to be NHS not private bodies. “Let us not throw out the NHS plan with the bathwater,” he said.