Friday 13 January was memorable for many reasons, but the main one was the announcement by Prime Minister Theresa May that GPs should do more to help A&E departments by opening 12 hours a day, seven days a week or risk losing funding.
Friday 13 January was memorable for many reasons, but the main one was the announcement by Prime Minister Theresa May that GPs should do more to help A&E departments by opening 12 hours a day, seven days a week or risk losing funding.
It showed how out of touch she and her advisers are with how the health service works. There was a theory it was a ‘dead-cat’ trick – where you throw a dead cat into a room to distract everyone. Instead of the subject they were focused on, they now talk about the dead cat. At the time, there was a media onslaught about how poorly the NHS was performing against targets and a row was developing between Mrs May and NHS England chief executive Simon Stevens over the transparency of the funding promised to the NHS.
Notable was the lack of input from health secretary Jeremy Hunt. Despite being secretary of state for five years and presiding over the first all-out junior doctor strike and alienating the whole profession with his attacks on weekend death rates, he seems to have avoided taking any of the responsibility.
Despite an online petition for a vote of no confidence, Jeremy Hunt has the full backing of the PM as a passionate NHS advocate. This is a far cry from Direct Democracy, the pamphlet he co-authored in 2005, whose thesis was to de-nationalise the NHS and give patients the choice between private and publicly funded services.
The elephant in the room is what to do about social care. Hospitals are full of medically fit patients waiting for care packages or nursing homes. The hospitals then cannot meet their other targets of treating in 18 weeks or cancer care or the A&E target. The cuts in social care have put much more pressure on the system.
The problem of who pays for social care is something the PM can no longer dodge. In order to do that, she needs a better understanding of how it is paid for now. Primary care is on a block contract with fixed costs and resources. The system will break if we try to force more into the community without the resource. We are seeing this in Northern Ireland, where 97% of GPs voted to resign from the NHS. But that might be the master plan. Then the collapse of the NHS lies at their door.
The pressure on GPs to federate or form super-partnerships in order to survive is huge. This is paving the way to a fully salaried GP service, which may be attractive to the younger generation. The new models of care are leading towards American-style accountable care organisations (ACOs), where areas will be given a capitated budget for all care and have to live within that or raise more funding through local tax or voluntary contributions. These organisations will employ all their staff.
So Theresa May, by attacking GPs to deflect attention from the wider crisis, will be able to drive through the new models of care as a solution. Once the ACOs are formed, local politicians and healthcare leaders will be responsible for what is and what is not provided by the state-funded system. The ACOs will have the NHS logo but be de-nationalised organisations with salaried staff. And the dead cat becomes the rabbit out of the hat.
Dr Joe McGilligan is a member of council at the National Association of Primary Care and a former chair at NHS East Surrey CCG
