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..