Louise Boden

An email has come to my attention. It is from Louise Boden, the Chief Nurse at UCLH, and so she is no longer a clinician at all of course, but a manager, paid for out of tax payers money.

The email is full of hyperbole and half-truths, insults and implications about GPs in general. It is really very insulting about GPs. She obviously is very jealous of us.

Here is the text:

-----Original Message-----
From: Boden,Louise=20=20
Sent: 06 June 2008 07:54
To: Divisional & Senior Nurses; Nurse/Midwife Consultants; Clinical Nurse
Specialists/Practitioners
Cc: Heads of Nursing
Subject:Don't be fooled: this doctors' protest is all about profits, not patients

GPs are fighting the new polyclinics for the same reason they refused to join the NHS 60 years ago: to protect their businessThe British Medical Association has declared war on the government. Nothing new there, as the doctors' trade union sends out several press releases a day crying wolf about anything the government does. Next week is polyclinic protest week, with posters and leaflets in every GP practice encouraging patients to sign a petition doctors are taking to Downing Street.

The ideas of surgeon-turned-minister Lord Darzi mutated through various models - but finally emerged as 152 new clinics (London) or health centres of flexible size (everywhere else), which each primary care trust designs to suit its most needy area. But the BMA says they will "fragment care and destabilise existing services. Some surgeries may have to reduce services for patients while others could be forced to close." Scary warnings abound tha
t the era of the GP is over, bureaucracy will rule and your beloved local surgery will go the way of the post office. The BMA told PR Week it is digging into its war chest for a national poster campaign. The Conservatives have jumped on the Save Your GP campaign - something they may regret. So what's the problem the new clinics seek to solve? Although the nation's 8,500 GP practices do 90% of NHS work, hospitals take 80% of the cash. For decades
Labour and Tory governments have striven to get resources out of hospitals and back into the community, with more early prevention and less emergency repair. The other reason is to get a grip on bad GPs, which is difficult as they are private businesses. Most are good, but up to 15% are seriously inadequate - often single-handed practices in shabby premises in the neediest areas, in stark contrast with some of the most hard-working and idealistic GPs.

Polyclinics are only destined for London: elsewhere there will be health centres grouping several GP practices with new facilities. Lord Darzi's London model will be a hub around which are grouped existing local GP practices, often in the same premises - or new ones that fill in gaps. The hub will offer diagnostics and specialist clinics of all kinds; patients can walk in and see a GP, or be referred by their own GP. These clinics come with new
money from the centre and just two universal rules: they must be open from 8am to 8pm, and must see any patient who walks in. Does this sound like a threat or a promise? That may depend on whether you are a patient or a GP. It's hard to see a downside for patients. They will have access to a host of services nearby instead of in a distant hospital - and, joy of joys, at any time from 8am to 8pm. Where new health centres have opened recently - I
saw a beautiful one in Crewe - there has been a stampede of patients to join.

In one of their few firm policy commitments, the Conservatives seem to be making a bad error. They say they will stop the polyclinic and health centre programme - and, even more surprising, they won't make GPs open their doors outside office hours. Andrew Lansley, the shadow health spokesman, told Pulse magazine they would restore GPs' control over what hours they open, which oddly puts the Tories on the side of the union against patients' interests.However, the BMA draws its power from the trust people put in doctors but not in politicians, which may be why Cameron reckons he should hang on to their coat-tails as they march on Downing Street, pretending that "patient care will be damaged" whenever anything threatens their own terms of service. Cameron should ask Kenneth Clarke for his unfond memories of BMA tactics. Many decent doctors blench at the crude and dishonest shroud-waving
carried out in their name. The BMA fought tooth and nail against opening GPs' doors at hours to suit working people: the government won only a meagre three extra hours one evening a week, and no weekends. This is despite a 58% increase in pay when their brilliant negotiators pulled the wool over the eyes of John Reid and Alan Milburn - whose 2004 contract let GPs off all weekend and evening work for a puny =A36,000. (BMA negotiators could hardly believe it: they were expecting to lose =A315,000). The contract paid them if they hit 75% of their targets: they pretended that was tough but when they easily reached 92% they hit the jackpot. The National Audit Office said it cost =A31.78bn. Unsurprisingly, GPs have had no pay rise in the four years since, and that's part of the grumbling grievance behind this current campaign.

The BMA's petition to Downing Street will be shaped as a giant birthday card for the 60th anniversary of the NHS, so let's remember what happened back then. Aneurin Bevan failed to get GPs to the join the NHS, so they remain to this day private businesses. They have life-long contracts that can't be removed, with a guaranteed income, and large increments for doing things that should be part of their job. They own their businesses - and usually
their premises - and sell them on when they retire. As a result the NHS hasn't been able to ensure GP practices are spread to where they are needed most. The fact GPs are not direct NHS employees has always worsened inequalities in health provision as they congregate in richer, leafier spots. This BMA protest has nothing to do with patient care - and everything to do with jealously protecting what they see as a threat to their business model. So
it's hard to keep a straight face when the BMA scaremongers about "the threat to your surgery" from "commercial providers" who "will be more interested in their shareholders than patients". The BMA expresses indignation that more GPs might become directly employed by the NHS - but forgets to mention that a growing 35% of GPs are now directly employed by other GPs who meanly refuse to make them full partners in their businesses. Some contracts may
go to private providers - but the first has gone to a group of local GPs, and that is expected to be the model, except in rare cases. The new clinics will be built with various financial partnerships between the NHS, private funds and GPs' own investments. In the London borough of Camden and Derby, whole GP services have been contracted out to a private health company, causing consternation about creeping NHS privatisation - but these will remain the exception. In Camden the practices were already being run by the loca
l primary care trust and now open long hours, attracting more patients. But anti-privatisation campaigners are right to be wary: it is typical Gordon Brown triangulation that a mention of using the private sector has to be injected into everything to show he's a Blairite reformer at heart - as with this week's announcement that, as a last resort, failing hospitals could bring in private managers - though few expect it to happen: it was tried at Birmingham's Good Hope - and failed.

Of course polyclinics could go wrong. They could be underfunded and badly run. PCTs are not always good commissioners and could choose the wrong models in the wrong places. Clinics attracting patients may destabilise other practices - but frankly, that's the point. GPs who can't be bothered to join something offering new services for their patients are the very ones who may need a bit of destabilising. For all the fuss, London's 152 new clinics
will cover only 3% of GP services. But if they are half as good as promised, they may blaze a trail so that soon every patient will want one.

I will be passing this to the BMA as I suspect that a robust defence will be forthcoming (who am I kidding?!). There are many statements in this email which I suspect are not evidence based, for example that 15% of GP surgeries are seriously inadequate.

With colleagues like these, eh?

• I have just discovered that this is a cut and paste job from Polly "I love Labour" Toynbee in today's Guardian.