The leader of Britain’s doctors has warned that coalition plans to reward GPs for enforcing budgetary controls could fundamentally damage trust with their patients.
Dr Hamish Meldrum, the chairman of the British Medical Association, said the suggestion under revamped plans from the health secretary, Andrew Lansley, might lead to allegations that doctors were withholding patient treatments and referrals to increase their pay.
The warning, made on the eve of the BMA’s annual meeting in Cardiff, will be seen as another direct challenge to the government’s plans for the NHS. David Cameron has already been accused by Labour of being forced into a dramatic U-turn after ditching his original reform plans for the NHS in England.
Meldrum said the BMA has “great reservations” about government plans to reward GPs for the high-quality commissioning of services.
“If patients even suspected that their GPs might be rewarded for how well they do, and particularly how well they do financially in terms of commissioning – giving way to suggestions such as ‘You may not be referring me, you may not be investigating me, you may not be prescribing for me because that actually means money in your pocket’ – well, that would seriously damage the trust.
“While we have always argued that doctors must be a part of the decision-making process, it has to be in partnership with patients and done in a way that doesn’t undermine that trust,” he said.
He said that the relationship between patients and their GPs would be a theme throughout the BMA’s delicate negotiations with the government over the future role that its members would play in a changed NHS.
” At times of crisis, trust is more important than ever. There is a danger that this may be put at risk by some of the government’s plans.
“The public is not prepared to gamble with the future of the NHS, and doctors are not prepared to see this trust abused by government policies that could undermine the value of doctor-patient relationships,” he said.
An Ipsos Mori survey released by the association to coincide with the conference claims to show that doctors are the most trusted profession, with 88% of the public generally believing they tell the truth. The figure compares with 81% of teachers, 68% of clergy, 29% of bankers and 19% of journalists. Government ministers, on 17%, and politicians, on 14%, occupied the bottom two places. More than 1,000 members of the public were asked to say whether thy trusted people who worked in 21 different professions.
The association is in the middle of examining detailed government amendments to the original bill, and is expected to suggest further improvements, for example, in the make-up of clinical commissioning groups.
Meldrum cautioned the government on allowing cuts to be implemented without proper consultation of doctors and other professional staff.
“The government has correctly said that it is not going to cut the budget, but it’s not going to grow as it has done in previous years. We are going to have to use the money more wisely. I have not seen yet how those savings are going to be made.
“We will certainly react strongly to some of the knee-jerk, slash-and-burn responses in some areas where they don’t seem to be having those discussions. There needs to be a much more mature dialogue that takes place,” he said.
This week’s conference is expected to be a heated affair, as doctors debate the future of the NHS while struggling to comprehend government amendments announced last week.
On Monday, they will debate spending cuts within the NHS. The health and social care bill will be debated on Tuesday.
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