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A question of trust - Health Policy Today, Thursday 19th June

Tom Smith on today’s health policy debate.
During David Nicholson’s speech to the NHS Confederation, he talked about a recent visit to his GP surgery where he was asked to sign the BMA petition, ‘save our surgery’.  He declined but asked the receptionist how she was kept informed about what was happening to the NHS.  “Oh, Dr Soandso tells us about it, and he never lies”.   The continuing row over the future of general practice is increasingly becoming a question of trust.

A heated exchange of letters between Ben Bradshaw and Hamish Meldrum over the petition

In his speech, Nicholson said his refusal to sign the petition was met with a disgruntled response and there is a sense, it seems, within the Department of Health that some signed under pressure or false pretences, including GPs telling patients ‘blatant inaccuracies’ (Ben Bradshaw’s words).   The health minister has written to BMA chair Hamish Meldrum, asking him to condemn this behaviour.
Hamish Meldrum said he would condemn this behaviour, but had ‘yet to see any proof of it’.  Meldrum wrote, ‘I note that you say that you have widespread anecdotal evidence of patients feeling pressurised into signing the petition and that you have referred to this in the media.  It would be helpful if you could share this evidence with us’.
More generally, Ben Bradshaw criticised the ‘inaccurate and misleading statements being made by the BMA’ and was critical of the stance taken on the £250m made available to enhance primary care.  Hamish Meldrum replied that he would rather this funding was spent on existing services.
Reflecting the tensions between the BMA and DoH, Meldrum wrote, ‘I am sorry that relationships appear to have reached the point where we have to have an exchange of letters of this nature’.

In the House of Lords Ara Darzi accuses GPs of compromising their professionalism by misleading patients about plans

Things may get worse following comments from Ara Darzi in the House of Lords.
Management in Practice (a website for practice managers) reports that Lord told Conservative peer, Lord Naseby, that “patients have signed these forms [petitions] based on their understanding at the time of their visit to their GP practices that their practice is about to close”.  He said the plans were “not about closure” and declared himself “astonished at the doctor-led petition and alarmed that some patients have been forced or misled in signing petitions”.  
His more serious accusation is that GPs are compromising their professionalism by misleading patients in order to oppose plans.  “The trusting relationship between any clinician and patient is sacrosanct and is one of the key values that underpins our profession.  Misleading patients, breaking their trust by causing them unnecessary concern and worry breaks that professional vow we all take”.
While Darzi’s frustration is perhaps understandable, he is on difficult ground if he suggests that doctors cannot take a view on policy.  And it is also unfair to say that GPs are misleading patients – many GPs really do think the government is gearing up to privatise primary care.   Ministers have played their part in making the ‘polyclinic’ debate simplistic and have not been keen to get into public debate about policy.

Very little coverage for Alan Johnson’s speech to the NHS Confederation

There was very little lively language from Alan Johnson in his Confederation speech and not one newspaper reported it.  Paradoxically, this is probably seen as good news.  As conference chair, David Walker said when introducing him, “Alan Johnson was appointed to keep health out of the headlines”.  
Alan Johnson is probably the only member of the cabinet who punches the air and whoops for joy when he sees that his speeches have not been reported.  It means everything is on track.

The Sun says we should we ‘worried sick’ by polyclinics

Alan Johnson will not be pleased, however, that the press seem to have a limitless appetite for reprinting similar articles on polyclinics.
The Sun make a rare foray into health policy today.  Sun Health’s Dr Keith Hopcraft tells us why we should be worried sick.  He has three points: competition from polyclinics could damage your local practice; centralising services will mean further travel; there will be no continuity of care.

A lot of anti polyclinic stories in the regional press

Yesterday, several regional papers carried articles reporting the fears of local GPs.  The Newcastle Journal warned that ‘traditional GP practices could disappear from the north east within a few years if controversial changes proceed’.  It is a typical of a number of stories that are whipping up public anxiety about the potential closure of services.
The headline in the Blackpool Gazette succinctly summarised BMA policy in a single word headline, “NO!”   In Blackpool, local GPs fear that the Fylde coast area will be infiltrated by commercial companies.  In a great bit of rhetoric, Dr Tony Naughton told the paper, “sharks now cruise our waters”.  
He said the petition was “just the start.  Next week we host protest meetings”.