From this coverage, you may think that this was a rabble rousing letter. In fact, it is much more "on the fence" affair seeking membership views. In effect it is a cover letter for a survey. The full text of the letter is produced below.
Of course, there are ifs and buts. For example, the wording of the letter is very leading. And the full results of the survey will not be published; and Clare can mine the data for her agenda.
However, the coverage is excessive, and may further induce strident views from GPs in their response. All self-fulfilling . . .
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Here is the full text of the letter
Survey on the Health & Social Care Bill
Message from Dr Clare Gerada, RCGP Chair 21 December 2011
Dear RCGP Member,
As you know, the Health and Social Care Bill is in the final stages of its passage through Parliament and this will be the last opportunity for the College to seek your views. This short survey is designed to test out member opinion on recent developments in relation to the Bill and how the College should respond. I feel it is important to share this with all our members in the UK, not only to keep you up to date with the issues, but to gather as many of your views as possible as we prepare to take important decisions for both the College and the future of the NHS.
We have reached a critical moment in the College’s work to take forward our profession’s concerns about the Heath and Social Care Bill. When we look back in years to come, I want there to be no misunderstanding of the position the College has taken or criticism that we did not do enough to inform and engage members or to protect patients and the NHS.
Since September 2010, the College has articulated a consistent position in relation to the Health and Social Care Bill. Although the College has been active in raising GPs’ concerns - submitting a full response to the White Paper consultation last year, engaging with the Future Forum listening exercise over the summer and proposing amendments to the Bill to try and improve it – fundamental concerns remain and the NHS faces an uncertain, potentially very unstable future. We have not to date opposed the Bill outright but have made it very clear (pdf document) that it removes the systems and structures that underpin the NHS in England through:
The removal of the Secretary of State’s legal responsibility for providing a comprehensive health service. Dismantling the system of commissioning responsibility for area based geographically defined populations, replacing it with commissioning based on populations registered with general practices.
The overriding emphasis on competition and any qualified provider, rather than integration and shared working. Introducing new arrangements for postgraduate medical education and training, moving to a system of ‘Local Education and Training Boards’, funded by a levy. This will not be as fair, efficient or effective as the current system and may not safeguard the important role played by deaneries.
As the Bill has progressed through Parliament, further evidence has emerged which has deepened our concerns. The NHS Operating Framework for 2012/13 (pdf document) confirmed that Clinical Commissioning Groups (CCGs) will be asked to function on operating costs of just £25 per head of the population, a substantial reduction on current levels. In the meantime, draft guidance published by the Department of Health (pdf document) has raised concerns that the market for providing ‘commissioning support’ to CCGs will be dominated by a small number of large commercial providers offering end-to-end packages of support, undermining the principle that commissioning should be clinician-led. These developments – combined with the challenge across the NHS in England of finding £20 billion of efficiency savings – are resulting in a greatly altered landscape. If CCGs are given responsibility without power, there is also a risk that public frustration about the need to ‘ration’ health services could unfairly be targeted at GPs.
Repeatedly our surveys and communications with members have revealed that GPs are concerned that the reforms will weaken the effectiveness of the NHS and its long-term survival as a public service covering the whole population. For example, in our most recent snapshot survey of RCGP members in October 2011, 65.3 per cent of respondents expressed disagreement that theGovernment’s reforms would lead to more cost effective delivery of care, and 66.3 per cent disagreed that they would result in better patient care.
From the outset of the Government’s proposed healthcare reforms, we have been clear that:
- We fully support greater clinician involvement in commissioning and planning services for geographically defined area based populations.
- We believe that provider side reforms could deal with many of the issues without the need for repeated organisational change or many of the proposed reforms.
- In particular, we believe improvements could be brought about by models of care such as GP Federations, where practices can pool expertise and resources to deliver broader services to patients close to their homes, working as appropriate with other NHS, third sector and private providers.
Over the longer term, it is also important that we work with politicians and the public to determine what the NHS should be providing, how it should be funded and how, over the next decade we address the big health issues facing our population. It is our view of course that in order to create an NHS that is fit for the future, this must include more GPs spending more time with their patients.
As a profession we must now decide on a way forward which reflects our unique understanding of how these changes will impact on the health system we work in and the patients in our care. Should the College decide to call for the Bill to be withdrawn, there is no guarantee that this will be successful. Nonetheless, it is my view, and that of many others, that stopping the Bill now, placing GPs in the majority on the boards of the PCT Clusters/NCB outposts and focusing on addressing the serious financial crises facing the NHS, is the safest way forward for patients and communities.
It is important to note that as a registered charity the College is, and will always remain, party politically neutral in its stance on the reforms. We have been working with Government Ministers and the Department of Health team to ensure that the voices of GPs and their patients are heard as the implementation of the reforms progresses, and this is something we will continue to do. However, this does not prevent the College taking a professional stance on whether to support or oppose changes that affect us, patients and the NHS so directly.
As doctors, we need to justify our practice by reference to the best available evidence, and the evidence, little that there is, suggests that the changes being introduced through the Bill are not going to bring about the improvements in efficiency, quality or equity the NHS desperately needs.
Your views matter and will help shape this crucial debate. Please take a moment to to complete a short survey on this issue .
Yours sincerely,
Dr Clare Gerada Chair of Council
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