Private malpractice, profit and loss

Written By: Marjorie Smith
Published: May 10, 2011 Last modified: May 9, 2011

Andrew Lansley’s proposal that consortia of general practitioners in local surgeries should take control of National Health Service budgets is a recipe for disaster.

Most GP surgeries are private practices that contract their services to the NHS. Most are run as separate profit centres with the partners taking a share of the profits. They are paid by the NHS according to the number of patients they have registered.

GPs and their representative body, the British Medical Association, have long been the most reactionary element of healthcare in this country. Yet the Health Secretary wants to hand over the running of the NHS to them.

Many staff employed by GPs are non-unionised and earn little more than the national minimum wage. Even practice nurses are paid according to how much the GPs decide to give them and not according to NHS pay scales.

There are even differing pay scales between GPs, with practice partners employing locum or junior doctors at a significantly lower pay levels than they award themselves. In other words, the less practice partners pay in outgoings, the more profit there is for them to share.

Despite GPs’ attention to detail for certain patients  – those suffering from diabetes, cancer and heart disease, for whom they are paid bonuses – most of their income is predicated on the number of patients on their list, not on how many patients they treat. This situation can be compounded by partners employing salaried junior doctors to do most of the donkey work, while they reduce their own hours.

This has led to a culture whereby managers are employed in many practices to devise ways of providing the minimum care to patients. Reception staff are given strict guidelines of when a patient can see a doctor and emergency appointments are kept to a minimum number a day. Urgent cases are encouraged to go to NHS walk-in centres or hospital accident and emergency departments.

One of the most important aspects of the NHS is the strong element of trust between patients and GPs.  If this changes, then the fundamentals of healthcare change forever. How can a patient have full confidence in their doctor if the cost of treatment and what impact this will have on the consortia’s bottom line are permanent considerations?

Progressive reform of the NHS would reap more dividends for patients. If GPs were paid by the number of patients they saw and the quality of care they offered, rather than by the numbers on their list, the dynamic of the doctor- patient relationship would change dramatically. A simple use of a patient’s National Insurance number, given to all in the form of a swipe card, or their NHS number, would enable state payments to be made to GPs based on productivity.

In other European countries, doctors’ income levels are determined by the number of patients they attract to their surgeries. This is the case for both private and state funded patients. The same is true for consultants. A patient doesn’t need a referral from a GP if they know what’s wrong with them  – perhaps a specific physical injury or the recurrence of an already diagnosed condition.

The same principle could be extended to hospitals and the consultants they employ. In what other service would people be expected to turn up in groups of 20 or more at the same time in order to see an expert who then decides whom they see and in what order, rather than allotting precise appointment times for each patient?

Hospitals should not be exempt from reform. Poorly-run hospitals should not be allowed to continue unchallenged and unchanged. Different hospitals in the same area can have vastly different reputations. Why should someone be sent to a specific hospital by their GP, when they may prefer to go elsewhere?

Perhaps the most disturbing aspect of the Conservatives’ health plans is the covert privatisation that mirrors the worst aspects of the healthcare system in the United States. The system the Tories want to introduce gives an opportunity to maximise private profits.

The rationale for this may be to convert GP commissioning groups into the equivalent of health maintenance organisations. These private bodies were introduced in the US by  Richard Nixon’s administration in order to drive down health costs by limiting access. They ration healthcare for the middle and working classes. They restrict the choice of patients to a few specialists and a limited number of hospitals.

Groups of GPs, specialists and hospitals band together in an HMO. It is a mutually supportive relationship. Profits are boosted by limiting services to those provided by the HMO and refusing to pay for any service undertaken outside its reach unless first approved by the management. Profits are shared by the component parts of the HMO.

If the Tories get their way, a private company might be able to buy out a GP consortium and develop a strict policy of vertical integration, whereby patients would only be sent to hospitals or clinics owned by the private company in question. That would be the final nail in the coffin of universal healthcare.

It should be the responsibility of the state to fully fund health provision in the United Kingdom, as set out in the founding principles of the NHS. Only by giving citizens the power to make their own decisions can genuinely radical and progressive reform of healthcare in this country be achieved.