Suspicious minds: Politicians are running out of time to win GPs’ trust

There is one constituency that all parties will have to work hard for at the forthcoming election – GPs.

After witnessing at first hand the car crash of the NHS reforms, GPs have turned against the Conservative party and the Lib Dems. From a GP vote share at the 2010 election of 54%, support for the coalition parties has plummeted to just 20%.

But Labour is failing to cash in on this situation. Only 16% of GPs are planning to vote for the party, with the vast majority undecided about who they will back, with just months until the general election next May. UKIP, the Greens and the National Health Action party have increased their GP vote share, but not by much.

However, the 2015 election could be crucial for the health service. Hospital trusts alone are facing a £1bn deficit and the party in charge will have to make hard decisions on how to fund the NHS. There is already talk of charging for GP appointments and reducing exemptions for prescription charges.

A Pulse survey of 552 GPs reveals trust in politicians’ ability to run the NHS effectively is extraordinarily low. Almost half (47%) do not trust any political party with the health service. The disillusionment is profound and wide-ranging, with support for specific policies from the main political parties mostly below 20%.

It was all very different four years ago. After the 2010 election, a profession tired of Labour’s command-and-control style was thrilled as the new health secretary Andrew Lansley lit his ‘bonfire’ of GP targets. Labour’s flagship 48-hour appointment target, the patient survey and extended opening targets all went up in smoke to applause from the profession.

Some 35% of GPs said they voted for the Conservatives in 2010 and 19% for the Lib Dems, but the honeymoon did not last long. Just weeks after abolishing those targets, Mr Lansley’s infamous white paper was published, detailing his NHS reforms. It set out a breakneck schedule to abolish PCTs and replace them with GP consortia in England. That document started a reorganisation that splintered commissioning responsibility among multiple bodies, exposed the NHS to more competition than ever before and – according to most commentators – was a vast waste of time and money.

And as the NHS reeled from the effects of this organisational earthquake, Mr Lansley was replaced by Jeremy Hunt. Mr Hunt has proved a canny politician, able to present himself as the patient’s champion – and stick the knife into general practice in the process.

He has made welcome reductions in the size of the QOF and boosted the global sum component of GP funding. But his other policies have been anathema to GPs: seven-day opening; Ofsted-style ratings for practices; dilution of practice boundaries; the abolition of the Minimum Practice Income Guarantee; and a nationwide review of PMS contracts.

As he prepares for the election, Mr Hunt has told Pulse his main priorities for primary care would be to ensure practices have a ‘fair funding formula’ and to further cut back on bureaucracy.

His big idea is to publish much more data on GP performance to create a ‘learning culture’ in the profession. He says: ‘Peer review is a much more powerful tool than the blunt instrument of money and targets.’

But Pulse learned recently that plans to issue traffic-light ratings on a whole raft of GP data have been binned, and Mr Hunt has faced a major furore over his plan to ‘name and shame’ GPs over their cancer diagnosis rates.

‘My comments were somewhat misinterpreted,’ he tells Pulse. ‘But I do believe that across all areas that GPs operate, GPs need to know, and the public has a right to know, if they are outliers.’

There are encouraging signs that the health secretary is starting to recognise the pressure GPs are under, but many will still be feeling the effects of the puny 0.28% funding uplift he approved this year. The recent announcement of seven-day access to GPs is also unlikely to make him many friends among GPs.

Andrew Haldenby, director of right-leaning think-tank Reform, says the thrust of Mr Hunt’s policy is battling bureaucracy.

 He says: ‘I think the overarching theme is to be the voice of the patient as opposed to the voice of the system. Mr Hunt became secretary of state around the time of the Francis report, and he absolutely decided to ally himself with the patient.

‘Better access to GPs is entirely consistent with that. It is challenging a bureaucracy in order to provide greater access. [Former prime minister] Tony Blair had the same debates in 2001. That was 13 years ago, and we are still talking about it.’

The Labour party is most trusted out of all political parties on managing the NHS, with a fifth of GPs believing it would handle the health service better. But this is not translating into GP votes. Labour has increased its support among the profession by just one percentage point compared with 2010 (16%), although this could well change when the undecided make up their minds.

A glance at the response to its policies may offer a clue as to why support languishes so low. Just 30% of GPs support reintroduction of the 48-hour GP appointment target, despite a promise of £100m per year of funding to support it.

Only 16% of GPs support the party’s plan to devolve whole pathways of care for the most complex and vunerable patients from CCGs to health and wellbeing boards, a plan partly designed to reduce conflicts of interest. Shadow health secretary Andy Burnham’s recent announcement at the Labour party conference that GPs should be employed by large integrated care organisations, led by hospitals, has also caused a stir, although many GPs will welcome Labour’s pledges to increase NHS funding by £2.5bn, recruit 8,000 more GP and halt the cuts to practice income by abolishing the MPIG and PMS reviews.

Mr Burnham tells Pulse that his aim – if elected – is to ensure the NHS is ‘put back together again’.

He says: ‘We have to rethink how general practice might be. Whole-person care is about rethinking generalism, what good generalist care is and how health professionals might work differently to provide it.

‘I can envisage a future where we have more integrated care organisations that employ GPs.’

Dr Kailash Chand, deputy chair of BMA Council, speaking in a personal capacity, says Mr Burnham still has to convince voters.

The retired GP says: ‘People may not trust Labour, perhaps because of what happened when they were last in power… Andy Burnham, to be fair, was health secretary for barely 12 months, so he has a bit of credibility. He has to increase that credibility by explaining his plans more – that will get his trust level up.’

Support among GPs for the Lib Dems has plummeted to 4%, from the 19% who voted for them in 2010, despite often applying the brakes to the Conservative’s wilder health proposals.

They have struggled to show a distinctive offering to GPs, with their flagship policies – ensuring ‘parity’ between mental and physical health, and incentivising GPs to work in deprived areas – largely remaining unfulfilled.

‘Integration’ was the main buzzword for the party’s health spokesman Norman Lamb when he spoke to Pulse recently. He says that the future is for GPs to work in large ‘joined-up local systems’ with community services and mental health.

He says: ‘If it is commissioned as a whole package, you get the incentive to keep people healthier and not increase activity in hospitals. The GPs I have talked to are overwhelmingly in favour of that sort of change.’

But his support for widening the use of controversial ‘personal health budgets’ in the NHS may undermine his message. He says the cash funds that are handed to patients to use as they wish are a ‘good use’ of taxpayer’s money, although pilots showed some patients used the money to buy theatre tickets and laptops.

The overwhelming feeling in the profession is politicians should keep their hands off the NHS. As Dr Peter Swinyard, chair of the Family Doctor Association puts it, the political parties should focus on ‘not reorganising a damn thing’.

‘What they will be focusing on is access, availability, cancer diagnosis in one appointment however vague the symptoms, value for money, with ill-thought-through promises of 48-hour access and the nonsense of spreading a stretched and morale-free service to seven-day working,’ he says.

‘What they should be focusing on is reversing the trends that have caused GP morale to plummet and GPs to be deserting in droves, funding out-of-hospital care well to save money on in-hospital care, reversing the dreadful funding crisis in GP and restoring the percentage of the NHS budget invested in general practice to 11%.’

As our interviews over the next pages show, we are a long way from that.