Do you care about the NHS? If so read this

We have all read in the media and via politicians about the potential privatisation of the NHS but this doctor has posted the following on social media and it is being shared to raise awareness of new plans which he says “will destroy general practice in England”. We are not sure of the validity of the plans but felt that if you saw the post, you could make your own mind up. Read on.


You need to alert your GP to the dangerous new plans which will destroy general practice in England. They have been lied to by their union, the British Medical Association, who are colluding with these Government plans which will harm patients, the NHS and the profession.

Please read, share, cut and paste the text and get it to your GP.

Thank you

Dr Bob Gill

Dear Doctor …

I am writing to express my serious concerns about the new NHS Long Term Plan and new GP contract with which you are presumably at least partially familiar. The promotion material makes it all sound wonderful – a new integrated primary care system for all that claims to provide “the most value for patients out of every pound of taxpayers’ investment.” This is a misleading claim and totally misrepresents the reality which is a major shift of work out of hospitals with plans for more cuts, closures and loss of 30 million outpatient appointments; funding to do this additional work with a down-skilled medical workforce and seizing control of primary care GP list-based capitation budgets.

This Plan is to be implemented through a system of Primary Care Networks (PCNs) which will be the vehicles for a new Directed Enhanced Service (DES). Unlike previous DESs this will fundamentally undermine General Practice. You will have to sign a parallel contract to join a PCN by the 15th May 2019. A major change being rushed through before the BMA Annual Representatives Meeting and without a vote of the profession, is unprecedented and should in itself raise alarm. This will have legal force as you will at once become contractually bound. The PCN will then start to effectively take over your professional life.

It is envisaged that each PCN will have a minimum of 30,000 – 50,000 patients (though as high as 80,000 has been mentioned) on its list. Your patient list will be handed over to your local PCN, as will those of all the other practices in your PCN area that have signed contracts.

PCNs are the foundation of another new legal entity recently rushed through by government in secondary legislation avoiding parliamentary scrutiny. Called Integrated Care Providers (ICPs) and formerly known as Accountable Care Organisations (ACOs), they are the cornerstone of the American private health insurance system.

Under the new Plan and contract, access to doctors will be restricted and GPs will be required to mostly see patients with complex needs. The rest, when making appointments, will be diverted away by a “care navigator” to a pharmacist, physiotherapist, paramedic or other non-doctor substitute, thereby increasing the risk to patients of delayed diagnosis and wrong treatment. Myself and other patients will be seeing someone with a lower qualification who will be entirely independent of you (my doctor) and who will be unfamiliar with me as a person and the my medical history. This will result in a complete lack of continuity of care harmful to both doctor and patient. You will lose job satisfaction and experiential learning, I will get fragmented and inferior service putting my health at risk and eroding my trust. I will effectively cease to have someone I can properly call my doctor. This process of de-skilling the workforce is a key feature of American healthcare driven by the profit motive not quality of safety.

After a period of double running with your existing GP contract (GMS/PMS) your patient list and most importantly list-based capitation budget will become permanently locked into the PCN which will have access to all patient medical records and your performance measures (e.g referral rates, prescribing data) to be used to micro-manage you and determine whether you qualify for incentive payments. No more an independent professional with autonomy but just another cog in the PCN corporate machine with your value and influence diluted by the wider PCN team of non-doctors, all interfering outside of their capabilities, training (and putting them under pressure and professional risk) in formerly your patients’ care. Your are no longer my advocate but a functionary directed by top down objectives to save money by denial of care in order to meet targets. You will become increasingly reliant on the contracts negotiated by your local PCN, which will leave you largely marginalised. Further, you will be offered financial incentives not to send patients – me in other words – to hospital (including out-patients) regardless of clinical need. This will fundamentally corrupt the doctor-patient relationship, totally undermine your clinical efficacy, demean your professional integrity and betray your patients. Do you really want this?

The document issued by the government, BMA and NHS England (the latter, as you know, run by the ex-CEO of a US private health insurance company, Simon Stevens) sets out this Plan of so-called “Reforms” for a “five year framework”, and is all leading to the corporate take-over of ICPs (ACOs/HMOs) just as in America, at which point we will have switched over to the money-spinning, fraud-ridden, more than twice as expensive US system and with worse outcomes in which everyone – rich, poor, or middle class- is a loser. I urge you therefore NOT to sign the new GP contract, to urgently share this information with your fellow GPs and to educate your patients about this final step to turn our NHS into the for-profit, US-style private health insurance system.

Yours sincerely,