On Monday, LabourList carried Bob Piper’s call for any NHS organisation privatised by the Lib Cons to be brought back into public ownership without compensation. Such populism may be cathartic, but in the end amounts to empty rhetoric because it fails to recognise that GPs are – and have always been – located in the private sector having refused to join the NHS right from the start. Nye Bevan complained that he had ‘stuffed their mouths with gold’ only to persuade them to supply services to the NHS as independent contractors.
Handing control of the NHS to GPs is a form of privatisation, but it is privatisation by stealth with NHS organisations being disbanded rather than sold off. There will be nothing left to nationalise. And if Nye Bevan couldn’t nationalise general practice, its unlikely any future Labour PM could overcome the GPs’ trade union, the BMA.
Moreover Labour – and would-be leader Andy Burnham in particular – should acknowledge that its own reforms were directed at diversifying the health economy and at giving fattened GPs some competition. A couple of years ago I worked for a primary care trust introducing polyclinics. A couple of NHS organisations bid for this work as did some private sector organisations, including local GP consortia. Had the NHS organisations won the work, GP services would have come under public ownership for the first time.
Bizarrely Respect/SWP led an anti-privatisation campaign in support of local GPs who were concerned for the profitably of their practices. What the Trots didn’t know was that those same GPs had formed a consortium to bid for a polyclinic contract, which they won. Those GPs remain in the private sector and continue to make a decent profit.
Today’s GPs most commonly organise themselves into profit sharing partnerships, the model the BMA believes is most sustainable. Single-handed practices – sole traders – are less common today and some GPs find it beneficial to establish limited companies or follow other business models.
But Labour knows all this. Labour knows that the NHS sustains a diverse health economy because Labour largely encouraged it.
There is much to be concerned about in the Lib Con white paper, without Labour being disingenuous in its opposition. The so-called post code lottery will be far more acute, patients may register with GPs several hours from their homes if those GPs offer rare or expensive treatments like IVF and then fall ill, GPs may decide it’s more profitable to treat patients themselves rather than refer them to specialists, local authorities may need encouragement to invest in public health, GPs will be tempted to try cheaper treatments, there will be many opportunities for corruption and so on.
This debate will not be won by a Labour Party that behaves like those Trots who don’t understand the NHS at all. It will be won by a Labour Party that offers a real vision for the NHS and a clear route map for achieving that vision that starts from where the NHS is today.