Fundamental point:
the issue of finite resources v rising demand is one all countries are having
to find answers to. PCGs are one mechanism for this-who is better at sensible
rationing (assuming that rationing HAS to take place), a coal-face doctor or
faceless DoH buraucrat?? get involved and have your say!!
----------
From: [log in to unmask] on behalf of Peter Wilson
Sent: 29 March 1998 23:46
To: Howard Griffiths
Cc: Michael Durham; gp-uk; ePulse Editor
Subject: Primary Care Groups
Dear Sir
I have never written to a magazine Editor before and I've been a GP for over
fourteen years. The Profession is now faced with another major upheaval as
the Government seeks to implement the establishment of Primary Care Groups,
(PCGs) and we are told that membership is compulsory.
I object most strongly to this imposition by the Government and refuse to be
drawn into the process simply out of the fear that my non-participation will
lead to an even more disadvantageous position for myself as well as my
patients. It seems to me that the establishment of PCGs is effectively a
means of introducing the rationing of Health Care resources and it suits the
politicians' interests to have the public perceive this process as the
responsibility of the GPs running the PCGs. Other parties will be included
in the Groups but it is the GPs who will have to face the disgruntled
patients on a day to day basis.
If the compulsion and the rationing role is not enough deterrent then a
closer examination of the mechanisms within the PCG budgets reveal that our
own remuneration is indirectly threatened as GMS funds may be used to
counter overspends by the Group. Another worrying aspect here of course is
the predictable subsidisation of high spending practices by those who
prescribe or refer more frugally. Why should these two disparate types be
forced together? This aspect is especially worrying for those of us who
choose to be single-handed, i.e. in a partnership of one, who may now find
themselves in a partnership of fifty. I have no doubt that the PCGs will end
up being managed largely by the same power hungry, not clinically sated GPs
who thrive in these situations.
I feel that Doctors should ask themselves "Do these people really represent
my views?" The answer will probably be a resounding "No" although it will
no doubt be qualified with "But they are probably more representative than a
Health Authority administrator who will do the job by default." So, are we
to assume that GPs are becoming involved because they are either keen on
committee work (It's allegedly poorly remunerated if at all) or they are
motivated by the fear of being further managed by administrators. The
additional funding announced to date is hardly likely to provide a
significant comfort zone within which the PCGs can distribute their budgets
and so when deciding upon the local priorities there are bound to be cuts
which will impinge upon significant groups. Some might say that we should
then refer any complaints
of deficiencies onto the Group management. Others have suggested that local
MPs should be invited onto the committee but who will bear the brunt of the
dissatisfaction and the extra workload generated? It will predictably be the
same people who have had to implement other unpopular Government actions in
the past.
The message that I have tried to convey in this letter is one that I have
heard repeatedly, both locally, in the GP press and internet discussion
group and on the excellent "ePulse" but whilst most agree with the
sentiments they also seem resigned to the steamrollering PCG process. Our
leadership, certainly in my time as a GP has been ineffective in its
negotiations with the Government and in my opinion has not taken steps to
gauge the feeling of the profession as a whole in a matter where the
consequences could be even more profound than previous reshuffles. I know
from reading your magazine over the years that you have been responsive to
your readership and I have also voted in some of the polls you have
organised on our behalf. I suspect that GPs fall into four main categories
and I strongly feel that we deserve to know how many are opposed to being
forced into what has been likened elsewhere to a "shotgun marriage".
My perceived categories are:
1) Those who truly believe PCGs are a good thing.
2) Those who will support PCGs out of fear (Rather managed by a colleague
than by a manager).
3) Those who couldn't care less and who will acquiesce to anything imposed.
4) The mostly silent objectors.
For the reasons described above, in the absence of a major move towards type
(4) and their subsequent awakening, the first three will all end up neatly
wrapped in a PCG. The GMSC has no declared plans to hold a ballot of our
views and seems resigned to acceptance. In my opinion your publication could
do the profession a great service by organising a poll of your readership,
not only to determine "For" and "Against", but also to quantify the numbers
in my four groups. In a secret ballot Doctors are far more likely to voice
their fears as well as their motivation and the results could be presented
to the GMSC to encourage a formal regulated ballot of all GPs. It is
certainly my hope that this would give a clear mandate to our leaders to
reject our involvement in these (re)Organisations such that all may feel
able to declare that we're not interested in helping to ration healthcare or
in being forced into superficially disguised financial partnerships with
local colleagues of widely diverse opinion.
If the Government is determined to maintain the principles of the NHS then
it should find another means of funding and running it. I know there are
many who share my misgivings, indeed, this letter has culled information
from a variety of media but ....
"Everyone moans about apathy but nobody does anything about it."
Please help us in our time of need.
Yours sincerely
Dr Peter Wilson
GP, Broadstairs, Kent. <http://www.albionrd.demon.co.uk>
Medical Manager - EKDOC <http://www.ekdoc.com>
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