Government’s health policy attacked by G.P.s

Press, Volume CXIII, Issue 33251, 14 June 1973, Page 21

Government’s health policy attacked by G.P.s

1 B'j

DR R. M. RIDLEY-SMITH,

secretary, General Practitioners Society l

“Doctor knows best” might or might not be true when a general practitioner treats a patient. But when a Minister of Health—just about any Minister of Health—starts to treat the problems of doctors, the approach is invariably “the Government knows best.”

Despite reasonable access and opportunity for consultation, the doctors have achieved few significant advances over the last few years, and there is still far too little understanding of what the problems really are. It was, therefore, a morass, ■of neglect that the Labour 1 Party took over when it came Ito power. Country doctors !had vanished from many! (areas, the ratio of general; practitioners to population' had fallen continuously for; i 10 years, and the proportion [of the medical work-force; it was interfering with patient ! engaged in general practice; I had sunk to a point where: care.

Traditional interest

During the election campaign, the Labour Party had I emphasised its concern for I the health services, and, of ;course, an interest in social: [welfare is part of Labour’s J traditional thinking. i It was fair to expect that! ireforms would be made, and; that the new Minister of Health. Mr Tizard, would make full use of his opportunities. | Given the country’s pros-; perity, one might think thej only way to go was up. Six! months later, this is still possible, but Mr Tizard’s progress so far looks very much This is not surprising. The 1200 or 1300 general practitioners in the country exert little leverage, except by adopting the negative expedi- . ent of making themselves scarce. The Government is, after all, putting up the money, and is sure to be dictatorial about the way it is spent. . An invincible conviction : exists that, whatver else ; general practice needs, it can , hardly be money. This sort , of thinking has gone on for , so long, that of all the money • spent by the Government on , its health services, the ■ amount supplied directly to ( general practice has fallen ( to a pitiful 5 per cent, and j the Department of Health has . just issued a pamphlet containing figures which prove it. In fact, the only real ad-, justment—certainly no gain!' —made under the whole term p of the National administra--' tion was a modest increase;' in the General Medical Ser-;; vices benefit. This was recom- 1 mended by a Royal Commis- 1

sion. which was itself only; just capable of recognising; the extent of the rot. as if he has been led not; upwards, but sideways, into a| maze designed by his own' 'department. Although it was the Government’s decision to get rid of the Royal Commission, the kindest thing to say about its; steps to rehabilitate general .practice would be that Mr ■ Tizard has had the wrong sort of advice. Health centres In brief, the Government' [has pinned its hopes for the. improvement of general practice on to health centres —;■ ;almost all yet to be built.! ■ These will be Government-' j owned, and leased to doctors.; ! Staff wages are to be subsidised, to the extent of $35 ■ per person. This was stated in April, and last week, the Minister announced that the sum of $5 million was to be made available for building these centres. This is enough for 50; centres at $lOO,OOO each—enough to change the character of private practice for ; ever. ; Mr Tizard has said that' i “early opposition to. health! icentres by the medical pro-; fession had given way to enthusiastic support, and I today the role of the health ; centre in the community was 'accepted by the medical profession”. There is no evidence 'for this assertion. There is only one health centre in! operation. Some years ago, Health Department spokesmen, who admitted to a shortage of doctors only with great reluctance, took the line that the single-handed doctor was inefficient. The policy is now to be to discriminate against him in order to get him thinking properly. Where practicable, private groups of doctors all over the country already have banded together into group practices, and in fact Government loans were made available to help them do this. These groups represent a! worth-while advance in areas' where it was feasible to; develop them, and offer a good service, although not all: patients are necessarily; suited by them.

No subsidies

Now the Minister has indicated that these are not what ■he wants either. Privately- ; owned group practices, which I the Minister has said “may !be little more than an assembly of a number of individual doctors”, will not qualify for subsidies towards the wages of the ancillary personnel working in them. What the Minister wants, |in fact, is more socialised 'general practice, and if his health centres, built and [owned by local authorities, ! function with anything like (the efficiency of the average ‘hospital board, the tax-payers can start bracing themselves now for some horrible shocks. This is a sad turn of events, particularly important to the people of Christchurch. Private group practice in Christchurch has raced ahead. There are now 11 groups of at least three doctors each,

i with two more in the planning stages. The result has, I been a reasonable ratio of' [doctors to population, and a ,| high level of competence and ■ enthusiasm. ! It is astounding that these; group practices should now [be faced with economic sanctions, and until the Minister! 'changes his mind and treats; 'everyone equally, including isolo practitioners, the profession will react with drastic’ ■ loss of confidence. Considering the alternatives ;open.to Mr Tizard, if he had 1 ! really wanted to help, one must view these proposals,! made in regard to non- 1 (existent people in non-exist-lent buildings, as an opportunity muffed. '! The General Practitioner ;Society, by contrast, simply! !.asked general practitioners to*

rate in order of importance : eight overdue reforms. The first priority was for an 1 increase in the Genera! MediI cal Services benefit. The second was ancillary help for doctors and the third ■ was increased G.M.S. differen- ■ tial for home visits. Ancillary’help is needed for every doctor, whether in town or country. In recognition of this, the Labour Party said in its manifesto that it would extend the rural practice nurse scheme ;to urban areas. If it would get on and do this, and increase loans for ■ the building of group practices rather than commission health centres, and put up the G.M.S. benefit, everyone ■ would be much happier, and ■ we would all get better value > I for money.