Posted by: Witch Doctor | February 9, 2008

Back down then rise like a phoenix



You think the BMA was correct to back down over GP opening hours, My Black Cat?



If the doctors are to take on the government on their Poly Clinic / Privatisation / Commodity Culture / Brand Awareness / Pander to the Clients / God Help the Patients / Lean Staffing / Rotund Market / Dr Wall Street / Dr Boots / Dr Virgin / Dr Tesco / Dr Uncle Tom Cobly and all great healthcare bonanza then they do not fight the fight concerning a few measly hours of evening and weekend opening.

The doctors back off.

They enter their closet for a while.

And get their act together.

And shake up their union.


Shake them and shake them and shake them until the BMA’s teeth start to rattle.

They deserve it.

And once they are rattled, sharpen the teeth ready for biting.



What do they do next, My Black Cat?

They fight another fight.

And, this time, they, the doctors choose the fight and fire the shots.

Scud Missiles if necessary.

They stop pandering to, and stop allowing themselves to be manipulated by a malevolent government.

Evening opening is not the real issue.

The government knows it.

Some doctors know it.

But the punters (patients and clients) don’t.


The government INTENDS that doctors escalate THIS issue. Not more important issues.

The government INTENDS to reinforce the concept that GP’s are a lazy, money-grabbing bunch.

It is possible the government INTENDS that GP’s resign from the NHS.

Resign en masse.

Remember “Doing a Dentist.”

Some teeth suffered, but the dentists were OK.


Not now.

This is different.

Big multinationals were not hanging around in the wings when the dentists resigned from the NHS.



Giants like Tesco’s, Virgin, and Dr Wall Street.

Your ordinary GP will not be able to compete with these huge companies, some of them multi-national.

Ultimately, the GPs will have to be employed by them.

A few of them, in the new lean, very lean, workforce.

Not all.

So, it’s OK if some GPs take early retirement. The government can then REINFORCE TO THE PUBLIC the need for a new lean, very lean, workforce. Not enough GP’s. Not the government’s fault if GPs retire unpredictably. Is it?

There are alternative ways of working.

Ah, The Skills Escalator……..

You mean The Skills Leveler, My Black Cat.

The few doctors cocooned by “Competent Clinical Decision Makers”

Patients obstructed from seeing a doctor by “Competent Clinical Decision Makers”

So what should the doctors do, My Black Cat?

All doctors need to be aware of what is going on.

And they are not.

The BMA had better tell them.

The Economist is telling them:


“At first sight office hours seem an odd place to build the barricades. GPs spend most of their time on the very young, the old and the sick, few of whom are busy during the working day. A survey commissioned by the government in 2007 found that 84% of patients were happy with access to their doctors; only 4% wanted evening appointments and only 7% weekend ones. “If we’re talking about the public health of this nation, 30 minutes here or there is irrelevant,” says Nick Goodwin of the King’s Fund, a health-care think-tank.

Yet although those extra hours may be clinically irrelevant, politically they are dynamite. There is a growing perception that much of the extra money spent on the NHS has been wasted—and full-time workers resent paying the lion’s share for a service to which they have trouble getting access. “The moral high ground on which GPs have always stood is now wobbling a bit,” says Mr Goodwin.

Some doctors think that the government is picking a fight with family doctors in order to clear the way for a new alternative, polyclinics—huge multi-professional centres that are open all hours, perhaps run by private companies and employing salaried doctors. Last year Lord Darzi, a surgeon who is currently leading a government review of the NHS, produced a blueprint for primary care in London in which polyclinics featured heavily. Even before his task is completed, other areas are considering such arrangements. In Birmingham health-care managers have suggested amalgamating 76 existing GP surgeries into 24 larger, franchise-style operations, quoting approvingly the branding and customer service of supermarkets. Perhaps GPs had better think a bit harder about those opening hours.”

The Economist is damned right.

The GP’s better think a bit harder about opening hours.

They better think harder and bury the fight about opening hours.

For good.

Instead, they better grab THE WALL STREET BULL by the horns.

And the hospital consultants better get off their backsides and support them.

Eh, My Black Cat?

NB Thanks to NHS Exposed for leading the way to the Economist article.

redapple.jpg a red apple ……………………

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  1. I agree with you and I think this is what is going to happen Witch doc:

    Doctors leaders’ hours climbdown

  2. For once I disagree.

    If GPs go along with this then polyclinics et al are going to continue to be rolled out across the board, and the battle will be lost.

    GPs have to fight this government and I think they have a lot more backing than most people think.

    If they don’t fight this cause then I fail to see how the reform bandwagon will be stopped.

  3. Garth,

    It strikes me the government are poised now and very ready to take on the doctors over late night opening. On the other hand, they may be mightily un-nerved if the dark side of polyclinics were to be displayed to the voters right now. That’s what I think needs to be done.

    The trouble is, many members of the medical profession themselves are still very vague about the entire picture surrounding the NHS plan, and that needs to be addressed first – and quickly. Don’t hold your breath that it will happen though.

  4. Hi Garth,

    “If GPs go along with this then polyclinics et al are going to continue to be rolled out across the board”

    As Witch doctor says, this is a side line. The PM won’t let go of the extra hours because it doesn’t look good politicaly, hence, if the GPs don’t agree, there will be dire consequences, such as forcing the polyclinics in larger numbers! Birmingham’s 76 GPs are already under that threat as a ‘pilot’ programme.

    The idea is to accept the three hours for now to save the politicians face, then make demands by way of ‘pay back’ is more ‘diplomatic’ and will work better.

    Diplomacy is vital now, don’t forget the PM didn’t really like the health reforms when they were first started. This is an advantage doctors can always utilise.

  5. I don’t agree.

    The polyclinics are being forced through regardless, DoH are ordering 1 per PCT by end of 2008, independent of what the GPs do.

    Dilpomacy is vital, however bending over and taking it is not a good idea either.

    The government must be resisted on this, as we all know what a slippery slope polyclinics and privatisation are.

    A good PR campaign is what is needed here, people don’t want crappy impersonal portcabin medicine delivered by HCPs and lining the coffers of the health care corporations.

    The public need to be made aware of what the real implications of this reform are.

  6. The one good thing about the GP opening hours issue, is that it might help focus the mind of the medical profession on the bigger picture. It will make doctors receptive to any information they receive regarding the thinking behind the NHS plan. The majority of doctors are probably still not politically aware of all that is going on.

    It would be a high-risk strategy, however, for the medical profession to expect the public to be behind them on anything to do with doctors’ pay or terms and conditions. Hence it seems to me, tackling multinational controlled polyclinics is the best way to go to engage patients. And it is real “patients” that need to be engaged rather than “clients.” People who have never been really ill do not necessarily appreciate the importance of the NHS.

    I suspect, soon the time for diplomacy will pass with this government, although the “public “ will need to be told about the problems very carefully.

    As for Gordon Brown – maybe he disapproves of the health reforms, maybe not. He has spent an awful long time as Chancellor, and so he will be well aware of the profitability of opening up the healthcare market in the UK. If he is in the horns of dilemma, I suspect economic factors will win, and the polyclinics will march on.

    Wonder what the patients and doctors saying in Birmingham? And is anyone listening?

  7. Look at this

  8. […] Furthermore, My Black Cat, as we said before, this fight should not be fought on the GP opening hours smokescreen. […]

  9. […] Yes, My Black Cat, the GPs are coming out of the closet. […]

  10. […] the main polyclinic argument fell flat on it’s face with the voters. They don’t buy into The Polyclinic Dream. To confuse, he even had to get his “Lackies” to change the name to Health […]

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