The Tobacco and Primary Medical Services Bill (part 2)

So. Is this bill going to close the loophole that allows commercial providers in? Ye-no-ye-no-not-sure is the answer to that question. This was never going to be an easy bill to construct. It involved changing three pieces of primary legislation, and there was a danger that it was going to be in breach of European commercial rules. European commercial law means that if a contract is worth over £180 000, it must go out to commercial tender. There are no exceptions for health, despite health being a public service in so many European countries. The SNP approach to this problem was quite smart; the new legislation proposes that whoever holds the contract for the practice must be a health professional and be involved in the day-to-day running of the practice. The other shareholders must be individuals.This would appear to eliminate the likes of Serco, Tesco, Virgin and other non-healthcare providers of medical services so it's a good start. However, this starts to break down when you see the list of who is considered a 'health professional'. Their definition has been taken from section 25 of the National Health Service Reform and Health Care Professions Act 2002 and reads as follows;

(a) the General Medical Council,

(b) the General Dental Council,

(c) the General Optical Council,

(d) the General Osteopathic Council,

(e) the General Chiropractic Council,

(f) subject to section 26(5), the Royal Pharmaceutical Society of Great Britain,

(g) subject to section 26(6), the Pharmaceutical Society of Northern Ireland,

(h) until their abolition by virtue of section 60(3) of the 1999 Act—

(i) the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, and each of the National Boards for Nursing, Midwifery and Health Visiting, and

(ii) the Council for Professions Supplementary to Medicine and each Board established by or by virtue of the Professions Supplementary to Medicine Act 1960 (c. 66),

(i) any regulatory body (within the meaning of Schedule 3 to the 1999 Act) established by an Order in Council under section 60 of that Act as the successor to a body mentioned in paragraph (h), and

(j) any other regulatory body (within that meaning) established by an Order in Council under that section.

Or to put it another way, just about anyone in a white coat or blue tunic. Which leads me to this question;


What the hell is wrong with a GP contract being just that; a contract for GPs?

The answer lies in the debates around the bill. One of the words being bandied about is 'flexibility'. Having just one model of primary care is restrictive and there should be more 'flexibility' so that health care professionals other than doctors can hold a contract. Rural practices need more flexibility, it's argued, so it should be built into the bill.

I'm not really faulting the SNP here. Labour are breathing down their necks and the Tories have voted against the bill. They don't have much wriggle room. They are also boxed in by the fact that GPs are independent contractors, so the difference between them and say, United Healthcare in law is one of degree rather than kind. It's a hell of a big degree; it's like comparing the local grocer's with Tesco, but legally it's tricky.

So where do we go from here? To Europe is where I would suggest. All the trouble that we are having with this is Europe's refusal to recognise GPs as providers of healthcare in a not-for-profit healthcare system. Its insistence on applying commerical law to universal health provision is seriously mucking up health in not just our country, but in other European countries as well. And we all need to get savvy with Europe and what is going through it and who is responsible. The European Cross Border Directive is next and if that gets through, a whole new battleground in health is going to open. (Btw, it was one John Bowis from Britain who was responsible for it. And the wise guy has now retired.) To sum up; this is a good effort, probably the best that could be done under the circumstances in Holyrood, but I think we will be returning to it at some point. On of the big boys of private health is bound to challenge it and when it happens, we'll have to hope that the government in power is friendly to the NHS. Interesting times..

The Tobacco and Primary Medical Services Bill

The above bill is one of the most important bills to go through the Scottish Parliament in years. On it rests the future of primary care in the Scottish NHS, which makes up 90% of NHS services. It is an attempt to close the loophole in the original 2004 bill, that allowed commercial contracters into GP practices. It has passed stage 2 in Holyrood and now only has to pass stage 3, pending Royal Assent.

So why is so little interest being taken in it?

Of all the responses to this bill (and there are many) only nine refer to part 2 of the bill, which is the bit about GP services. One response from 32 local authorities (South Lanarkshire). Two responses from 15 health boards (Tayside and Dumfries and Galloway). One response from Edinburgh Uni and the Centre for International Health Policy (Allyson Pollock). One response from the BMA. One response from the RCN.One from Community Pharmacy Scotland. One from the CBI. And one from the Ayrshire and Arran GP subcommittee. (There are also individual responses, but it's not clear which part of the bill they refer to). So what's going on?

Part of this poor response is to do with the history of this bill. This is a classic Trojan Horse piece of legislation, where a very popular measure (measures to prevent the sale of tobacco to minors) was coupled with a far more dodgy one (opening GP practices to commercial providers). This made it very difficult to argue against and in the lead up to the bill being passed in 2004, the SSP were the only party to point out the GP bit. The tobacco part of the bill has continued to be a tin can tied to the tail of the Primary Medical Services contract; in reading the debates round the new bill, the irritation on the part of the debaters trying to split their time between two very different subjects is palpable.

Part of it is simply that many bodies are not aware of the debate surrounding the contract. The local authorities, including my own have taken a 'here be dragons' approach to part 2 of the bill and simply commented on part 1. The health boards have no such excuse; they have simply ignored the debate on the PMS contracts and commented on the friendly tobacco bit. I am however, very surprised and disturbed that only one university (Edinburgh) has picked up on the GP contract bit. This indicates that the politics surrounding medicine at the mo is not being picked up on. I don't expect a debate like this to make it into the public sphere that often, but I do expect it to be present in the medical schools of the universities that produce our doctors and on this showing, it's not. So what's happening with the bill and will it close the loophole in the GP contract? Time for another post..

How to Shoot Yourself in the Foot Before an Election

Politicians and journalists are a bit like love and marriage; you can't have one without the other. Politicians are nothing without the press. The press are nothing without stories. However, it is a marriage of convenience rather than love. Politicians do not like being in thrall to journalists; neither do journalists like having their stories being interfered with. The carrot and stick that the government use to keep the press under control is public notices and the advertising revenue that goes with that. If the journalists play nicely, they'll get to advertise stuff on swine flu, planning applications, dates of public meetings etc. If they don't play nicely, that gets withdrawn. With the national press this doesn't work entirely; they still get revenue from big private firms' adverts, but for small local presses this is their lifeblood. Local government is usually their single biggest advertiser and without that revenue they will struggle very badly. This is why local papers tend to be blander in their reporting and fill their columns with endless pictures of the provost presenting the latest road safety prize to wee Calum McDougall down Whifflet way. They do occasionally show their teeth and when they do they can be lethal. The backing of Jean Turner by the Kirkintilloch Herald in 2003 was one of the major contributing factors to her election as an MSP and the government has not forgotten it.

Or have they? I read with incredulity today that the Scottish Government was planning to end the mandatory requirement to print public notices in papers. Instead, they can be displayed online. This will save £6 million of much needed public cash goes the argument.

I confess that I am absolutely flabbergasted at this. Not at the injustice of it, because lots of people do not have access to the internet, but at the sheer boneheaded political stupidity of it. You're five months, maybe less, from an election. What better strategy than to administer a kick up the backside of every local press from the Dundee Courier to the Airdrie and Coatbridge Advertiser?

I predict this is not going to last long. Even now as I speak, local presses will be reaching for those pictures of the provost that could scare the weans away from the fireplace. They will start printing all the stories that they had been sitting on for fear of losing the government's custom. Instead of 'Caring Councillors Come to Aid of Local Pensioners,' it will be ' Big Bertie and Busty Blonde Basement Romp in Council Chambers'. It'll be over in a matter of weeks.

You have been warned...

Farewell to the Queen Mum

Today could not go past without mentioning the end of a Glasgow institution; the Queen Mother Maternity Hospital in Yorkhill. It closed its doors after 46 years of bringing Glasgow's weans into the world. It was a rather ungainly concrete building perched on a hill just above the West End and you had to throw a double six to get a parking space, but it was an old friendly warm place that had the buzz of competence and the air of friendly conspiracy that you get amongst women waiting to give birth. Two of my friends were treated there; one of them had cancer as a complication and they were superb with her. I am truly sorry to see this place shut and the inevitable break up of the specialist teams that will go with that. I wonder with the constant political interference that goes on, if Glasgow will ever be able to build up a place of such standing again. Truly you don't know what you have until you've lost it..