Open message in response to the letter to the Telegraph - "NHS in peril"

Dr Gordon

I am interested to note your letter to the Telegraph, which has been taken as support for the efforts of the Government to eventually replace our National Health Service, funded exclusively from taxation, with a patient-focussed English Health Service, funded by patients with some central government support. Articles such as this Daily Telegraph piece have presented you and your colleagues as opposing efforts to encourage parliament to reject the bill that would enable this to come about.

I see that 5 of your co-signatories are not currently in general practice, however it is 8 of the remaining 50 that cause me most concern.

I refer to:

Dr Andy Harris	Dr Amit Bhargava	Dr Kamal Bishai	Dr Stephen Madgwick
Dr Vaishali Nanda	Dr Stewart Findlay	Charles Broomhead	David Eyre-Brook

With the exception of the latter, all serve in practices which use 084 telephone numbers, in breach of the revisions to the respective NHS contracts, which were introduced in 2010.

Dr Eyre-Brook's practice is used as a case study for the most widely used surgery telephone system that is allegedly funded exclusively by patients, and provides an additional 2p of income for the surgery - see "Surgery Line sounds too good to be true".

I raise two points with respect to this matter and these individuals, given that the replacement of the NHS referred to above has not yet occurred.

•    If these individuals are thereby seen not to be personally committed to the principles of "our NHS", as they stand and will remain, then one must question their suitability to have a leading role in procuring NHS services.

•    If, as some have alleged, those who procured these telephone systems for NHS surgeries were not aware that they would be funded by patients, then one must question their competence to lead bodies concerned with commercial matters.

It is vital that NHS money is spent wisely and that current clinical experience, derived from engagement with patients in general practice, is deployed to ensure this.

We cannot however have decisions made within the NHS led by those who are content to disregard its principles, because they support an alternative system for healthcare in England, or who are ready to believe sales pitches that are "too good to be true".

It is my personal view that GPs are better able to serve the NHS from outside its structures, rather than taking on the responsibilities of a public servant. I see their professional focus and skills as continuing to be best focussed on meeting the clinical needs of their patients, regardless of cost to the public purse. Responsibility for the effective, equitable and accountable management of public resources is an onerous and quite separate duty. I accept that we must differ on that point, or alternatively you believe that the NHS will have effectively ended in England from the point when CCGs acquire their authority.

If the latter were to be true, then those who accept the responsibility of public servants would no longer be required to ensure that publicly funded health services were only delivered "free at the point of need". The leaders of CCGs would thereby be able to focus exclusively on patients, without having to be concerned about the wider public interest and nationally set principles.

I would be pleased to hear any response from yourself and from the individuals who I have identified and copied.

If the practices in question may believe that they are not in breach of their contracts, because all callers subscribe to the few telephone tariffs that cause them not to pay more than the cost of an equivalent call to a geographic number to call a 084 number, then I must draw their attention to an appeal from Simon Burns, Minister of State (Health Services).

Responding to a debate in parliament on this matter last Tuesday (Hansard Column 54WH 24 Jan 2012), Mr Burns said "... we need the evidence. We do not need anecdote or the 'friend of a friend', who has said this or that. We need precise, concrete evidence, to be able to pursue this matter" ... "I say to the right hon. Gentleman, and to anyone else who has an interest in this important subject, ‘Please send us the evidence’".

If these practices have complied with the contractual requirement to "consider whether, having regard to the arrangement as a whole, persons pay more to make relevant calls than they would to make equivalent calls to a geographical number", then this evidence will be readily available. If your colleagues wish to show themselves to be keen to protect the NHS from the perils of "co-funding" then I am sure that they would wish to clearly demonstrate that they and their practices reject this and are compliant with their contractual obligations.

I would also be very interested to see a copy of any such evidence myself, as I cannot see how it could possibly have been assembled.