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..