Polyclinics could "spell the end" of traditional GP services, warned the leader of the British Medical Association's (BMA) GPs Committee today (12 June 2008) in a fiery speech.
In his opening address to the 2008 Local Medical Committee conference, Dr Laurence Buckman (pictured) criticised the government's "broken promises" and warned it would "not get GPs' trust back easily".
In a speech to more than 400 GPs from across the UK that earned him two standing ovations, Dr Buckman began: "GPs have continued to suffer from a government that seems not to value what we do and is intent in offering our work to someone else. They should be ashamed."
Commenting on government plans to open polyclinics in every area of England, Dr Buckman told the conference: "This dumbing down of general practice will spell the end of the generalist who can offer holistic care. It will see the rise of clinics further away from the patients they serve and providing much less of the personal care and commitment they value.
Perhaps as a subtle swipe at Lord Darzi, the surgeon and health minister leading the introduction of polyclinics, Dr Buckman asked: "Who could have dreamed this up? Someone who knows nothing about primary care."
Citing the recent King's Fund report which found no evidence that larger GP practices deliver better care than smaller ones, Dr Buckman said: "No doubt this will be ignored as the government continues along its evidence-free path."
Continuity of care is vital and undervalued by ministers, he said. "Patients come to us because they see us as providing continuity – something that matters to many. When asked how long we spend with patients we can say '25 years'. The government is chucking that away at their peril."
He said patients "value continuity above speed of access. I am in favour of infinite access but not when it means that your families' access to you is reduced, and not when you are made to work to the point of exhaustion. Quality matters as much as quantity".
Referring to the two options presented to the GPC on extended opening hours, Dr Buckman said the government's method of consultation was akin to saying: "You can be hung or shot".
He went on to lambast the "rigid directed enhanced service" for longer opening times he said was "unsafe, unfair and unworkable".
Dr Buckman said the NHS should be investing in existing GP premises and staff rather than private finance initiatives (PFIs) for the benefit of private shareholders. "It will cost the country a fortune over the next 25 years. Better premises are the key to the better services GPs are itching to provide," he said.
"I do not think the public voted for a commercialised health service at the last election," he added, saying: "Voters don't want funding to move from GP practices to commercial companies who are accountable primarily to shareholders rather than patients. They want to be treated as patients, not customers."
Practice-based commissioning was one of the main ways the NHS could develop, said Dr Buckman, adding this was an area where there was agreement with government.
He said: "My message to Gordon Brown is this: "Whatever you think of GPs, take note of what your electorate thinks. We're not saying we're perfect. We want to improve. But work with us to do that, not against us, and ignore at your peril the wishes of the most important people in the NHS – the patients."
Your comments: (Terms and conditions apply)
"I totally agree with everything Dr Buckman has said. Our local rural Wychwood GP Pranctice in Shipton under Wychwood Oxfordshire is the "jewel in the crown" of how GP practices should be managed. We have walk-in GP surgeries Mon–Fri plus walk-in practice nurse surgeries both morning and afternoon and a loy more quality services besides these. All this will be lost if the government have their way" – Christine Crosby, Oxfordshire