By now most of you will have heard that the Tories have asked local party groups whether they think there should be a cap on the number of GP appointments that NHS patients (excluding those in Scotland, as responsibility for the Scottish NHS is devolved to Holyrood) should be allowed in a year. The original news report, which appeared on The Independent’s website on Sunday morning, has understandably got a lot of people scared, and I decided to investigate further. The discussion brief is freely available on the Conservative Policy Forum website, so anyone who is interested can download it to peruse at their leisure.

The question on allowed number of GP visits only comes up as a minor point, tucked away at the end of the 14-page paper. It’s one of a number of questions which are designed to be provocative, and it seems the media have taken the bait. In focussing on such a narrow part of the paper, they’ve missed some of the equally abhorrent content in the rest of the paper, which is a bit too complex to make a good headline. For those who can’t stomach an entire Conservative policy consultation in one sitting, here’s my summary:


Section 1: Dentistry

The paper starts of by explaining that the demand for NHS dentistry is so high that many patients find it difficult to get access to treatment. It also describes the links between poor dental health and other conditions, and the higher prevalence of tooth decay amongst children in schools where more than 30% of pupils receive free school meals.

At the end of the section, local Conservative Policy Forum groups are asked to vote:

In dentistry and in general healthcare, the highest demand for services is often not in the areas of greatest need. Which of the following statements best reflects the opinion of your Group?

Areas of highest health need should receive the most money in order to prevent higher healthcare demand later

High demand indicates people taking responsibility for their own health and they should be rewarded with the most money

 Basically, “do you think we should fund dental care for the feckless poor, or the pushy middle classes?”. Remember that Conservative ideology generally promotes individual responsibility.

2. Local doctors’ surgeries

This section is on the role of GPs in the NHS, more specifically about how primary care should adapt to cope with an ageing population, and it offers a lucky bag of possible solutions.

The paper’s unnamed authors cite research by the King’s Fund, a think tank which mainly comments on financing and management of the NHS, on how coordination between “federations” of GP surgeries in one area can allow them to provide a greater range of services. Also discussed are the benefits of doctors using consulting rooms in branches of Sainsbury’s, and the use of telehealth technology, which allows patients to monitor things like blood pressure at home and have the results transmitted to their doctor.

 More worryingly, it also uses examples of other European countries which have a specific set of “core services” which citizens are entitled to as part of insurance-based schemes. Although setting out a basic entitlement sounds like a good idea, applying this idea to the NHS would actually reinforce the idea that certain types of treatment aren’t essential and that patients shouldn’t automatically be entitled to them. If this principle was applied to the NHS, it would entrench a “postcode lottery” system of entitlements, with NHS trusts able to pick and choose which services they are willing to offer and to whom. In both of the case-study countries, Switzerland and The Netherlands, patients can opt for an insurance policy which covers more than the minimum entitlements, and it seems logical that defining a bare minimum of NHS treatment would create a booming market for private health insurance. It sounds like Thatcher’s vision of the NHS as a safety net for the poor, only with Blair’s PR.

3. Better Integration

At first glance, a lot of this sounds like a pretty good idea. It’s talking about ways to integrate the systems which provide hospital in-patient treatment and social care so that older people don’t have to languish in hospital while the local authority puts together the care package that would let them go home. However, this section also suggests greater integration of primary (GP) and secondary (specialist) care, and ends with the question:

Treating people in hospital is often more expensive and less effective than treating them within or close to home. How can we encourage more General Practices to offer advanced treatments usually administered by hospitals (for example, scans or hernia operations)?

In the case of hernia operations, it should be pretty obvious why patients should be treated in hospitals – they’re usually done under general anaesthetic, and in the tiny minority of cases where this causes complications, hospitals are much better equipped to deal with it.

4. The Role of non-NHS organisations

 This section briefly mentions charities, before moving swiftly on to private sector providers. As this is a Tory document, no one should be surprised that “competition” and “patient choice” are presented as unquestionably positive developments. However, the question at the end of this section is still quite nauseating:

As the NHS becomes more advanced and innovative, and welcomes a variety of providers from all backgrounds, how can we help patients to choose the most appropriate options for their health and social care?

5. Quick fire round

 These are the deliberately controversial questions designed to spark debate. Because, you know, it’s not as if these issues affect people’s lives or anything.

Local groups are asked to record whether their members strongly agree, agree, disagree, or strongly disagree with the following statements (presented in full and without further comment):

  • GPs should take greater responsibility for out of hours care in their area

  • The ability to see your GP or consultant for a routine appointment in the evening or at the weekend is a luxury the country cannot afford

  • The ability to see your GP or consultant for a routine appointment in the evening or at the weekend is important to keep the economy moving

  • Families should be responsible for the care of their infirm relatives

  • Families should be financially incentivised to take responsibility for the care of their infirm relatives

  • Patients who repeatedly miss NHS appointments without good reason should have action taken against them

  • There should be no annual limit to the number of appointments patients can book to see their GP

  • It is right that all NHS treatment is provided on the basis of need – including for those illnesses worsened by lifestyle choices such as alcohol intoxication and obesity

  • Britain cannot afford to fulfil all the health expectations of all the population all of the time

  • Open competition within the NHS is unnecessary

  • Open competition within the NHS is undesirable