Resolution proposed at Welsh Labour Party Conference 14 February 2015

Conference notes increasing pressures upon NHS Wales – acute hospital care especially. Conference pays  tribute to NHS staff operating the service 24 hours a day and 365 days a year giving skilled and compassionate direct patient care. Conference notes that unlike private sector companies the NHS does not walk away from its commitments when the going gets tough.

Conference offers its support to Welsh Government in  redesigning the total care system in Wales so that primary care services in general and family doctor services in particular are resourced to meet the challenges now faced.

Conference urges that Welsh Goovernment commits to substantially increasing a directly employed family doctor workforce – housed in modern publicly owned premises – operating and working as a team to complement hospitals  – so that doctors aspiring to a career in general practice have a salaried, public servant  route into this key foundation of the NHS like their other health colleagues.

Speech proposing motion  

NHS Wales has been under deliberate sustained political attack by the Tories despite evidence that NHS Wales compares well with NHS  England and despite the Barnett formula giving Wales 10% less money for our NHS than is spent in similar English regions. Our broadly comparable performance however  is where the similarities end with England.

Wales cherishes the founding principles of the NHS. The Tories and UKIP look to bring American style health care to the English NHS.  The English NHS is crippled by PFI debts from which Wales is almost totally free. England wants one NHS hospital to compete with another – and with the private sector  – with struggling  clinical colleagues, hospitals, and family  doctors pushed under rather than helped.  Regulators, inspectors, competition lawyers, Price Waterhouse Cooper  and accountants abound.

While the Coalition stands idly by as Lansley’s chickens come home to deposit their droppings all over Jeremy Hunt,  in Wales we understand that the care system has to be seen, resourced, and managed as a whole –  its component parts working collaboratively. One crucial part of this system is our family doctor service where over 90% of NHS patient contacts happen.

Since 1948, the family doctor service has been the bedrock on which the rest of the care system depends.  Effective prevention of illness, early diagnosis of serious conditions,  skilled management within the practice, and accurate early referral to specialist services, are among the key tasks that GPs must do well if the rest of the NHS is to work. But that bedrock is in trouble. The old independent contractor model of  GPs as self- employed business people contracted to the NHS to deliver a range of activities – is increasingly fragile.

SHA knows that there are some in general practice that jealousy guard their independent  status. As long as they deliver quality care and treat their staff in a fair and decent way, we have no argument with that. But the world of general practice is changing. Fewer and fewer doctors wish to run small  businesses and fewer are  attracted to the bureaucracy and administration involved in owning a practice. Many cannot afford, or do not want to be tied down by, the inflexibility of general practice partnerships. They are interested only in practicing medicine and delivering health care to their patients. This is why they became doctors in the first place.

If we are to ensure that general practice continues as the bedrock of our NHS we must offer these doctors new ways of working.

Many young GPs are already voting with their feet. They choose to work as salaried doctors rather than become partners in a business. The BMA recently told an Assembly Health & Social Services Committee that 40% of its GP members under 45 years are working as salaried GPs  – with most as salaried GPs in existing independent contractor practices. Just as hospital consultants, nurses, health visitors, physiotherapists and others work as public servants in the NHS, new doctors wishing to become GPs should also have this option.

This motions calls on the Welsh Government to establish a public service family doctor system for Wales with salaried GPs working with salaried nurses, health visitors, mid-wives, social workers and therapists to provide integrated and holistic care. We propose this in the knowledge that the other three independent primary care services – dentistry, pharmacy and optometry  – have passed almost totally to the control of the  corporate private sector. If we do not offer a public sector primary care option for general practitioners more and more of our general practitioner service will inevitably be delivered by the corporate private sector – as is happening in England.

This motion urges Welsh Government to continue to develop primary medical care with NHS Wales as a good  employer of a dynamic, enthused and high quality primary care work force. I beg to move.

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5 Comments

  1. george Nieman says:

    As long as we do not abandon the NHS this could be of help

  2. The simple truth is, why spend time and energy tinkering; when if Labour were genuinely wanting to save the NHS they would adopt Dr Allyson Pollock’s Reinstatement Bill.

    Link: http://www.nhsbill2015.org/category/allyson-pollock/

    1. Irwin says:

      It is not a Bill – it is only half finished and some difficult parts are still missing.
      Nobody has ever explained how changes on the scale envisaged could be implemented, what would be gained and at what cost – until this is done nobody can discuss it seriously.
      The key is to remove the market architecture and move forward to a modern care system not go back 30 years (even if it were possible).

  3. Richard B says:

    Excellent – the ideas around future for GP practice is equally applicable to England.

    One quibble. English system is a mess but not crippled by PFI debts. The excess costs of PFI are £100m’s out of £110bn of total expenditure pa. Most PFIs were indeed an expensive way to finance buildings and the contracts were daft and everything should be done to renegotiate and enforce properly but the scale needs to be kept in context. We in England have more than enough real problems to solve!

  4. bhfisher says:

    Excellent. We need to explore different models for primary care. Do we know how much such a public service system would cost?

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