Busting the myths about ‘saintly’ GPs

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Handing power to GPs is a central purpose of the Health and Social Care Bill. But it is based on many myths about GPs being closer to patients than other healthcare professionals

The whole NHS reform is based on an assertion – that GPs are somehow better placed to decide what NHS services need to be provided because they are in some sense ‘closer to patients’.

However the news that GPs seem to be failing to provide adequate services to elderly people in care homes raises doubts about this assumption (I have tweeted about it and had an interesting exchange with ‘TheNiceLadyDoc’, a GP).

Let’s take motivation first – are GPs closer to patients in the sense that they have their (patients) interests more at heart than others? Well, I know plenty of hospital doctors, nurses, physios and health managers who would dispute that. Of course, institutional factors may affect motivations. A doctor in a GP practice is in a different institutional setting to a doctor in a hospital. The former is a private contractor, the latter an NHS employee, for example. How might this affect their motivations?

The idea that GPs are inherently somehow more ‘knightly’ (to use Julian Le Grand’s terminology) than the more ‘knavish’ hospital doctors or managers is plainly ridiculous. There can just as easily be Harold Shipmans in GP practices as in hospitals.

One incidental point is worth making here about individual wrong-doing and institutional context. It is much easier for a GP in a singleton practice to get away with what Shipman did than it would be for a doctor in a hospital.

Next, information. It is assumed that GPs somehow ‘know’ what their patients need better than hospital doctors or NHS managers. But how true is this? Many patients in urban group practices see different doctors every time they visit the surgery.

So GPs don’t necessarily know what individual patients need. Indeed, some patients with serious health problems will actually see much more of their hospital-based specialist medic than they will their GP, who will essentially be an on-looker in the process. GPS are generalists and by definition in a poor position to out-guess specialists in every field of medicine about what patients with specific conditions need.

So, maybe GPs are better placed to assess collective health needs of patients rather than of individuals? Again, this is true to some degree – GPs will get a (necessarily subjective) sense of what their particular group of patients need. But that of course is subject to bias, to missing out on rarer conditions, or potential patients who don’t or can’t present (eg, dare I say, elderly people in care homes?).

So GPs do have access to some types of patient information that others in the NHS don’t, and they may have to some extent a more ‘holistic’ view, but in other areas they have little or no knowledge at all. The myth of the saintly, well-informed, GP who ‘knows best’ is a comfortable throwback to the age of Dr Finlay and cosy fireside diagnosis.

So if the NHS reforms are based on a systematic myth, the question is why? The answer is rather simple. GPs are potentially the back-door through which private contractors can be brought in to run the NHS. They are themselves private contractors, and some will certainly see personal advantage in the new arrangements.

Others will simply want to get on with being doctors, and hand over their commissioning role to a combination of other GPs who want the job and private companies offering attractive packages that make the ‘problem’ go away.

The new CCGs will also serve the purpose of shifting services from hospitals to community. This is a good thing. But it will also just happen to be shifting services from publicly owned hospitals to, in many cases, privately run community providers.

GPs have been unjustifiably elevated to a special, almost saintly, status in the health debate with one sole purpose – to use them as a back-door route into breaking up and privatising NHS provision. As far as I can see the Health and Social Care Bill still does precisely that.

This blog first appeared on Whitehall Watch

About Colin Talbot

Colin Talbot is Professor of Government in the School of Social Sciences (Politics), University of Manchester, and a former adviser to the Treasury select committee. He writes and comments widely on public management reform. Colin has worked with numerous national and international public sector organisations, as an adviser, consultant and researcher. He blogs at Manchester Policy Blogs.

4 comments on Busting the myths about ‘saintly’ GPs

  1. Dr A Ghani says:

    This is so uncharacteristic of a professor working in a well known business school !
    There is no logic or reasoning to supposed conclusion by our esteemed professor.
    One would expect from him a much thorough assessment of this very complex situation with GPs role in the proposed health bill.

    As a GP who spent most of my training years trying to find ways & acquire skills to assess my patients needs, I find the professors comment very much off the mark.
    If only Mr Talbot spends sometime in primary care settings ,he would understand the very central role of GPs in health provision where despite all the odds, we try our best to work in the best interest of our patient.


    Dr A Ghani GP in Slough

  2. Colin Talbot says:

    Dr Gani,

    I have spent all too much time in primary and hospital health care settings – as a patient. I have ample opportunities for ‘participant observation’ as well as to examine the search evidence.

    My point is not that GPs are bad at what they do, on the contrary in have gat admiration for most if them. My point was that in terms of motivation GPs are no more, or less, dedicated to patients that other health care professionals in, for example, hospitals. Nor do I believe they are uniquely qualified to know what patients need – there are many specialist areas and people for whom this will not be the case. So I reject the notion of some ‘special’ position for GPs that means they should be driving the healthcare system.

  3. ANM says:

    All discussion at present about NHS reform is missing the point that all our well qualified and motivated health professionals are simply working in a disfunctional and bloated bureacracy. Nobody wants people to have to pay for medical treatment in the UK – not the public, the professions, the Right or the Left. However, Govt spends around £2,000 per person funding the NHS. This means a town of 10,000 people, with perhaps 10 GPs, should have a budget of £20 million to fudn thir practice and procure the health care its population needs. If they had this responsibility, the first thing that would happen is that primary and preventative care would improve because it saves money. Anyone who thinks the £20 million would be more efficiently spent in the NHS should go run a business. Arguments about “privatisation” are flat-earth in nature. When you’re ill, nobody cares who provides the treatment; what matters is how good it is and how quickly you get it. We need a proper mixed economy in health – does anyone seriously believe a nationalised BT monopoly would be a better way to run telecommunications in this country? (And don’t point to Railways or Energy – in both cases, government was half-hearted and/or tried to rig the markets). With the population ageing, we need fewer hospitals in fewer places, more specialism and far more primary and preventative care. GPs need to own the budget and obtain vaue for money in the way they spend it. Changing to that system would make life a lot more uncomfortable for most health professionals and this is what they are opposed to. Meanwhile, nobody owns the £120Bn we spend on health so vast sums continue to be consumed by a bureacracy that still posts letters to people.

  4. roger kline says:

    ANM appears to live in an evidence free universe.

    There is plenty of evidence that, notwithstanding the waste that certainly goes on, the NHS is extremely good value for money, and that it was getting better at what it did. It is certainly likely to be better value than whatever “mixed economy” ANM envisages.If ANM has evidence to the contrary I’m sure he or she can share it.

    Colin Talbot’s pooint surely stands. No one doubts many GPs are dedicated hard working and caring professionals. The question is – where is the evidence that they are better positioned or qualified than other professionals to lead the NHS?

    Lansley has produced none because as far as I know there is none. I recommend readers go out and buy Colin Leys’ and Stewart Player’s excellent little book The Plot against the NHS. The real issue is not whether GPs should lead. It is where all this Bill is leading to.


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