John Bryant, chair of the Camden Council health scrutiny committee, kept the best to last this evening, as after a long and sometimes heated debate about Camden NHS’s draft primary and urgent care strategy (formerly Camden PCT), he concluded that the committee would be recommending that all work on the tendering process for the proposed new GP-led health centre at Euston be postponed until after the public tendering process.
The long evening began with the PCT reps (I’m going to call them that for clarity) setting out at length the well-known facts about Camden’s healthcare problems, with huge disparities resulting in the 10 year gap in male life expectancies between the richest and poorest wards, the 20% of deaths due to smoking, and 29% of people being “hazardous drinkers”.
We also got at length the polyclinic network strategy, which aims to see GPs linked together, developing specialities and providing extra services, something broadly no one has problems with (although there are questions about the removal of district nurses into the larger structure).
Then we got to the crux of the evening, the proposed GP-led health centre. Local campaigners – and the local community, as demonstrated by a huge public meeting this month, about which I had a letter in the CNJ this week – have expressed strong opposition to the plan, but tonight the PCT people, grudgingly, under questioning by councillors, admitted that they had already gone a long way to securing the building, and had begun the tendering process – all of this before commencing consultation, which is scheduled to start in July.
They say that they don’t have to consult on setting up the GP-led health centre, since that is mandated by the government, but only around the associated services. Whether indeed they are so directed to set up the centre was one of the evening’s key points of contention.
The Camden Local Medical Committee (an elected body representing all doctors working in general practice, with a statutory role), which expressed its clear opposition to the GP-led health centre, quoted a letter from then health minister Ben Bradshaw saying “these developments will only take place where it is ascertained after local consultation with the public and with GPs and other healthcare professionals that they will improve patient care for local communities”. This letter was also quoted by the Camden Keep Our NHS public delegation.
The PCT people in response quoted a letter from an NHS London bureaucrat; as one of the councillors said, you don’t have to be an expert on bureaucratic status to know that the minister trumps a bureaucrat.
They said they were now working fast because “London is behind the rest of the country in terms of timelines” (for setting up these GP-led centres). By the department of health targets they should already have delivered it, they said, but there had been confusion over the difference between polyclincs and GP-led health centres. (Although there still appears to be confusion: when a councillor asked about the way the new centre would be administered, who would be in charge of it, there was no answer.)
So what’s wrong with the GP-led health centre plan? This is how the Local Medical Committe puts it:
* We challenge the argument that this is a ‘must-do’ for the PCT
* We regret the lack of consultation with local GPs and patients
* We are concerned that resources will be diverted from other practices
* We do not accept this as the best way to address alleged ‘underdoctoring’ or health inequalities
* Patients of neighbouring GPs will not want their practices destablisied or forced to close down.
* Seeing unregistered patients will be costly, and will disrupt continuity of care and patient safety
* The procurement process is weighted against local practices and potentially lacks transparency. It ha also preceded local consultation
* We do not believe independent sector providers will improve health outcomes or patient satisfaction; nor will they increase access to GP care.
It wasn’t set out this evening, but the grapevine suggests that the PCT has on its initial shortlist four tenderers, of whom only one is a consortium of local GPs, with the rest being private providers, including American multinationals. It was explained that to bid for such a centre cost 50,000-60,000 pounds, with the big commercial operators expecting to get one in three or so of those bid for.
As well as the threat to GPs, this is one of the chief sources of opposition to the scheme, considerable complaints being expressed about the service being provided at the three local surgeries has handed over the American multinational United Health.
The delegation makes its point on the council steps:
You can find the agenda and the draft strategy here (and the NHS reports are in the appendix at the bottom).
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