Pretty Polly Toynbee is looking after the poor people again

Polly Toynbee at rest

When I started NHS BLOG DOCTOR a couple of years ago, I soon came across the DK, the ageing Greek and Tim Worstall.  All three seemed mysteriously unified in their hatred of Polly Toynbee. As Polly increasingly frequently turns her champagne socialist hand to the NHS I begin to understand why she was so disliked. Today, she has produced a tendentiously headlined concatenation of half truths, misrepresentations and down right lies about GPs.

Don't be fooled: this doctors' protest is all about profits, not patients
GPs are fighting the new polyclinics for the same reason they refused to join the NHS 60 years ago: to protect their business (Polly Toynbee)

Let’s take a rational look at Polly’s article.

The British Medical Association has declared war on the government. Nothing new there, as the doctors' trade union sends out several press releases a day crying wolf about anything the government does. Next week is polyclinic protest week, with posters and leaflets in every GP practice encouraging patients to sign a petition doctors are taking to Downing Street.

We are at war in Iraq and Afghanistan. The BMA cannot “declare war” on anyone. Polly and the general public see the BMA as the doctors’ trade union. It is not. Many doctors are not members of the BMA. Those who are members are not consulted about BMA policy. The BMA is more of a pressure group. Its authority comes from the fact that the government chooses to negotiate with it. There will not be posters and leaflets in every GP practice. There will not be any in mine. I am not too fussed by polyclinics.

Although the nation's 8,500 GP practices do 90% of NHS work, hospitals take 80% of the cash. For decades Labour and Tory governments have striven to get resources out of hospitals and back into the community, with more early prevention and less emergency repair. The other reason is to get a grip on bad GPs, which is difficult as they are private businesses. Most are good, but up to 15% are seriously inadequate - often single-handed practices in shabby premises in the neediest areas, in stark contrast with some of the most hard-working and idealistic GPs.

The funding balance between primary and secondary care needs realignment. Agreed. Polly is out of touch, though, about patient demand. Polly lives in a posh part of town. She is wealthy. She has a villa in Italy. She is one of the affluent worried well who think that getting advice about their cholesterol levels constitutes a medical emergency. For most people, Polly, preventative medicine is not top of their agenda. Most people have had enough of the nanny state. Stop drinking. Stop smoking. Lose some weight. Use condoms. Take more exercise. All good stuff. But most people do not want GPs to devote their time to this. They want to be able to access their doctor quickly when they are ill. 

15% of GPs are seriously inadequate? Where does Polly get her figures from? What are her criteria for “serious inadequacy”? Of course, she does not say. Single handed GPs are all in shabby practices in needy areas? Really, Polly? Some of the finest GPs I know are in single handed practice.

Lord Darzi's London model will be a hub around which are grouped existing local GP practices, often in the same premises - or new ones that fill in gaps. The hub will offer diagnostics and specialist clinics of all kinds; patients can walk in and see a GP, or be referred by their own GP. These clinics come with new money from the centre and just two universal rules: they must be open from 8am to 8pm, and must see any patient who walks in. Does this sound like a threat or a promise?

Let’s think about that Polly. So, for example, eight general practices, each with three partners, covering a large area of outer London are going to be uprooted and moved to one large super brand new health centre. A hub. Hmmmmm. “Hub”. Like that, it has a buzz about it. How much is it going to cost to move all these practices to the "hub"? And specialist clinics in the “hub” as well. So hospital doctors will have to abandon their hospital clinics and move out to the “hub” where they will work without their normal infrastructure; their nurses, their secretary and so on. And what about all those elderly people who go to their local three-doctor practice? Now they will have to commute to the “hub”.

Polly, the “big is beautiful” argument has been going backwards and forwards in the health service since 1948. There are good arguments for polyclinics. There are also good arguments for single handed GPs. There is no moral absolute here.

That may depend on whether you are a patient or a GP. It's hard to see a downside for patients. They will have access to a host of services nearby instead of in a distant hospital - and, joy of joys, at any time from 8am to 8pm. Where new health centres have opened recently - I saw a beautiful one in Crewe - there has been a stampede of patients to join.

Now, Polly, that was silly wasn’t it. You are making me giggle. I wonder why you were in Crewe recently? I wonder why the government supported new health centres in Crewe recently? Were the electorate impressed, Polly?

Polly is perfectly entitled to be in favour of Polyclinics just as the BMA is entitled to be against them. You might have thought she would have been capable of a rational discussion. But no, now her article descends into flagrant mendacity.

The BMA's petition to Downing Street will be shaped as a giant birthday card for the 60th anniversary of the NHS, so let's remember what happened back then. Aneurin Bevan failed to get GPs to the join the NHS, so they remain to this day private businesses.

True. GPs were terrified of signing up to be salaried wage slaves in a Labour organised health service. So they stayed self employed. The consultants also retained their right to practice privately.

They have life-long contracts that can't be removed,

Untrue. GPs can be “removed” for all sorts of reasons, and sometimes are. And Polly, it is not a contract. It is terms and conditions of service imposed on GPs from above.

with a guaranteed income, and large increments for doing things that should be part of their job.

Income is not guaranteed. It depends on the number of patients who sign on, and on the amount of work you do. The QoF data chase has generated substantial payments but most of the work done was nonsense. Designed by the government focus groups and nothing to do with caring for healthy patients. Yes, GP's pay has risen over the last three years. But averaged out over the last 15 years it has barely kept pace with inflation. GPs had fallen so far behind that there was a recruitment crisis.

They own their businesses - and usually their premises - and sell them on when they retire.

Polly, that is dishonest. GPs have never been allowed to sell the goodwill of their business. It is illegal so to do, and always has been. Most GPs work in local authority health centres. Some have bought their own premises. The ones who have bought their own premises will sell them on to younger doctors when they retire. What is wrong with that?

As a result the NHS hasn't been able to ensure GP practices are spread to where they are needed most.

That is simply not true. The NHS has for years provided additional financial support to set up health centres where the are “most needed”

The fact GPs are not direct NHS employees has always worsened inequalities in health provision as they congregate in richer, leafier spots.

Congregate? I don’t think so Polly.

This BMA protest has nothing to do with patient care - and everything to do with jealously protecting what they see as a threat to their business model. The BMA expresses indignation that more GPs might become directly employed by the NHS - but forgets to mention that a growing 35% of GPs are now directly employed by other GPs who meanly refuse to make them full partners in their businesses.

It is certainly true that GPs do not want to surrender the little independence they have, but Polly fails to understand the problems of general practice. Five years ago, it was impossible to find new partners. We advertised for one and whereas 10 years previously we had over a hundred applicants now we got none. Not one. Newly trained young GPs were not prepared to commit to partnerships. The pay had fallen behind and the future was uncertain. We had no alternative but to take on a salaried doctor even though we would have preferred a partner.
Polly is, as I say, perfectly entitled to take a view on polyclinics. She is perfectly entitled to criticise doctors if she wishes. But if she is going to do that, she should at least get her facts right.

Her article is offensive, full of hate. Like every other man and woman in the country, doctors want to improve their income. Her imputation that doctors are lazy, uncaring and cynically chasing money at the expense of their patients is outrageous. It is also upsetting and demoralising. Most doctors are decent, honourable people trying to do a good job in increasingly difficult circumstances.

The worst thing about Polly is that she has prostituted her journalistic credentials for a cheap headline. She purports to know what “ordinary people” (to her the “common folk”) want and need from their doctors. Heavens, she has even pretended to be poor  for a few weeks. Gosh, that’s brave, Polly.

She has not got a clue. Ignorance is bad enough for someone in her position. But it is worse than that. She is dishonest. She is a hypocrite. She has no understanding of ordinary people, or their needs.



When she is not in her Italian villa, she sits in her spacious Victorian house in one of London’s most desirable suburbs, regally handing out pieces of intellectual cake to the poor folk.