FORUM - Complex issues for all of us concerning healthcare - says Dr Rhiannon Lloyd

Published: 16 September 2010

AS a Camden resident, but a practising GP in Brent and founder member of Harmoni GP co-operative, I have read the letters and editorials in the New Journal and Evening Standard with interest. 

I sympathise with the financial problems of Camidoc, a popular local co-operative which has lost its contract as a result, but am concerned about the focus on Harmoni “bad”, Camidoc “good”, that has been generated, when the real issues are far more complex than this.   

Harmoni started life as a co-op, just like Camidoc, and continues in my area of London to provide the same care for my patients. The reason it is described as a private organisation is that a separate provider (private) arm was set up some years after we started in order to bid for the provision of out-of-hours (OOH) services in other parts of London; thus Harmoni is a company limited by guarantee and pays no dividends. 

It was clear at that point that in order to continue providing the good clinical care, for which the original organisation had become known, and to remain financially viable with all the increasing layers of governance and complex regulatory requirements in the evolving NHS, it was imperative to expand. Without this the organisation would have become unstable, a problem it appears Camidoc has experienced. 

The new company has successfully bid for and provides OOH care to large areas of London and around the country and has an excellent reputation. The reason for this is its reliance on local GPs working in its centres, financial probity and a robust HR structure, good IT links with its practices, excellent training for staff, and co-ordination of nursing, end-of-life care and mental health and social services links. 

I am sure that Camden residents will not suffer from a change in the quality of care it provides and that Camden GPs who currently work in Camidoc will be able to continue to work in the new organisation. After over 10 years I am still happy with the care it provides to my own 13,000 patients.

The wider picture is more complex.  

Harmoni’s expansion was a result of the already creeping privatisation of the NHS under the last government, which is about to be rapidly accelerated under the current one. It was felt that a GP/clinician-led organisation with its roots and ethos in the NHS was needed to bid for contracts against the growing number of private companies also bidding. Camden has already experienced this in the contracts awarded to United Health Care to run the practices in the south of the borough.

It must be remembered that GPs themselves are private businesses albeit ones that contract solely with the NHS and under the new white paper they will now have to form consortia to control budgets which are vastly greater than the OOH service. The problems Camidoc have had may soon be a common problem on the pages of our newspapers as GP consortia fail to provide a service in a budget-driven, savings, economy. 

One of your letter-writers implored people to go to A&E instead of using an OOH private organisation when you are ill. 

This will soon be misguided advice as the A&E service is itself a prime target for the private companies. A&E and walk-in centre attendances are paid on a cost-per-attendance basis. This price, amazingly, is similar per one visit to what your GP is paid for the whole year for your entire medical care, regardless of how many times you visit. 

In my own area a contract has already been awarded for A&E services to Care UK, a private organisation (a contract that Harmoni also bid for). This provider will welcome you with open arms as often as possible, the contractual emphasis of throughput and activity, at unit cost, not necessarily encouraging good evidence-based personal medical care. 

The money for this will come out of your GPs’ budget and reduce the amount they have left for your other care including the hospital services for which they will now be sole commissioners. 

My message is: don’t blame Harmoni, which is a great GP-led organisation striving to provide good quality care in an environment which seems intent on opening the doors to many other organisations without the same ethos. There are much greater risks out there. 

We need an honest and open discussion about what the NHS should provide and also what it should not, how much we are prepared to pay for universal health care, free at the point of access, and how and who should be providing it. 

The issues for the future are much wider than Camidoc and Harmoni.