Editor’s blog Thursday 10 June 2010: BMA GP chair Buckman's clarion call for NHS small-c conservatism

Oh dear. Oh dear oh dear.

The BMA's LMC conference has escaped, into the real world.

Whatever is said at the LMC conference has to be taken with a pound of salt. This is where the BMA talks to itself.

Unfortunately, they invite or press release all of the trade press; not just Pulse and Healthcare Republic

And sadly, in his speech to the annual LMC conference today, the entertaining BMA GP Committee chair Dr Laurence Buckman has not distinguished himself by a knee-jerk opposition to modestly modern approaches to managing the NHS.

It appears as if James Johnstone's old "give us £100 billion a year and leave us alone" ethos may be coming back. This ill-serves the BMA.

Damning the silly and the sensible alike
Buckman wants “consigned to the dustbin of history” some things that are bad but we're stuck with them (PFI), and some that are plainly useful (the GP patient survey and data generated by the NHS market).

Buckman's 'baddies' are:
Wasteful PFI schemes - valued at £10.9 billion, but set to cost the taxpayer £62.6 billion by the time the final payments are made in 2048. (And he's right - the government can and should refinance these with cheaper borrowing to reduce overall costs)

Management consultants - £308.5 million was the total spent on external consultants in 2007/08. In some cases, the NHS is paying external consultants up to £1,000 a day. (Management consultants have some uses, in some cases - it's about using them intelligently)

Some tiers of NHS management – Many management jobs seem to exist with the sole purpose of supporting successive NHS reorganisations and top-down initiatives of the previous government. Micro-management of GP practices is expensive and unnecessary. (Name these jobs. No, the 21st century won't leave general practice alone, sorry, but that is public money and you are going to be more acountable)

The GP patient survey - Survey results have been consistent since 2006, yet last year alone it cost the government £13 million to run the survey. The view of the BMA’s General Practitioners Committee (GPC) is that detailed and relevant feedback could be more usefully and more economically gathered locally from patient participation groups or local patient surveys. (PPGs are usually tame; national surveys allow comparison across the country; patient views are here to stay)

The bureaucracy of the NHS market - It’s estimated that the ‘internal market’ has increased NHS overhead costs from 8% in 1991-92 to 11% in 1995-96 and increased administrative staff by 15% and general and senior managers by 133%. Since 1995 Department of Health statistics show that the number of senior managers has risen by 91%, more than double the 35% increase in the total number of doctors and nurses. (Yes, but unlike a decade ago,  the NHS can now have rational conversations about activity and costs, and will soon be able to assess outcomes. As a result of the internal market. This is where healthcare is going.).

He also objects to the “Choose” element of Choose And Book, which is "laboriously bureaucratic and requires a lot of expensive NHS staff time, and management. The system is now regularly used to ration demand and meet the 18 week waiting times target by PCTs". (Which will be why GPs get 31 pence a time for pressing the keyboard).

Buckman likewise opposes "the building of new walk-in-centres and Darzi clinics - existing centres need to be properly integrated with local services. However, new centres should only be opened after adequate consultation and an assessment of local need has been carried out". (And of course by far the majority of GP health centre contracts went to - you guessed it - existing GPs - 30%).

The giveaway
Buckman's clarion call for conservatism is outed in the following line (my emphasis): “We, and our hospital colleagues, will all need to pull together in order to agree, if we can, what can stop without damaging patient care. We may have to accept that some parts of patient care may have to change too. Nobody will want that, but if it has to happen, at least let us see how we can minimise the effects on our patients.”

Now that is not selective quotation. Nor is it really correct. Most people want patient care to change - for the better.

Buckman and colleagues disliked and opposed it, but extended hours and daily 8-8 centres have widened access to primary care, and it needed widening.

We are going into a time of huge opportunity for GPs to take real leadership and active participation in shaping the health service for the 21st century. There will be down-side risks, of being associated with tough and unpopular decisions about rationing care (which hitherto can currently be safely blamed on managers and politicians). Hands-on means hands dirty.

But there is a great opportunity here. If the BMA is serious about supporting its membership, it needs to be leading the conversation about these things. The future of healthcare commissioning and provision is about more data, used more; more partnership working across sectors and boundaries. The future of healthcare is not about The Olden Days.

Buckman is a doctor who has genuinely-held public service values. It is a shame that here, his chosen attack weapon was the sawn-off shotgun, rather than the sniper's bullet. Noise and mess are no substitute for accuracy.