Gamekeeper Turned Poacher-Still Stuffing Their Mouths With Gold”-Part II
The creation of the NHS wasn’t smooth, especially with doctors. Many GPs and consultants opposed it because they feared losing independence and becoming salaried state employees.
To get them on board, Bevan, the Minister of State for Health at the time, made compromises, most notably allowing GPs to remain independent contractors rather than direct NHS employees (which still shapes the system today). He later famously said: “I stuffed their mouths with gold”, referring to financial incentives, favourable contract terms and concessions to consultants and GPs.
GPs remain as independent today as they were in 1948 and in the past thirty years, they have been more and more drawn into commissioning roles and positions of influence.
Under Margaret Thatcher, the NHS remained publicly funded, but key changes opened the door with the 1983–1985 (Griffiths reforms): introduced general management instead of consensus management. In the late 1980s competitive tendering for services like cleaning and catering began, the first real outsourcing. This is often seen as the starting point, but not full “privatisation.”
The real turning point is the National Health Service and Community Care Act 1990, under John Major. This created the “internal market” and Split NHS into purchasers (health authorities/GP fundholders) and providers (hospitals). It also encouraged competition between NHS bodies and later with private providers
Under Tony Blair and Gordon Brown, the Private Finance Initiative (PFI) expanded massively (private sector builds and runs hospitals). Introduction of Independent Sector Treatment Centres (ISTCs) run by private firms and more use of private providers to reduce waiting lists.
The biggest modern acceleration came with the Health and Social Care Act 2012 under David Cameron the key impacts of which was giving legal footing to competition and tendering and expanding role of private providers in delivering NHS-funded care. Commissioning was also shifted to GP-led groups (CCGs). This is often cited as the point where “privatisation took off” in a systemic way. This is when private sector involvement scaled up significantly, even though the NHS stayed free at the point of use. Many analysts see this as when market logic properly entered the NHS.
Privatisation of the NHS has been developed by both the Labour and Conservative governments and has been with us in some shape or form since 1948, The NHS is not privatised in the full sense as it is still tax-funded and universal. The question remains as to whether this counts as “privatisation” or just “outsourcing/marketisation”
Thus, Olympic Health is not a new concept although its closer integration with an organisation seen as providing essentially NHS funded GP services blurs the edges between NHS care and private care a little more.
It is interesting to note the disparity between Companies House listing of Dr Abbas Tejani as sole director of Olympus Health and as ‘1 active person with significant control ‘and yet Olympus Health lists three others under its director’s page. Strangely each of their profiles is a cut and paste of Dr Tejani’s own profile. Of the three said directors two are also associated with the Willows Medical Centre run by Willows Group Ltd, Professor Vinay Gupta and Professor Tariq Kapasi are directors of both Willows Group Limited and Olympus Health.
Never-the-less, and mindful of the caveat that the blurring between the operations of GPs and private providers under the auspices the Leicester, Leicestershire and Rutland Primary Care Network need to be closely monitored to ensure strong governance, there may well be benefits to Olympus Health operating across Evington and beyond.
Primary Care Networks are groups of GP practices. In Leicester, these sit under the ICB and influence local service design, funding allocation and referrals into community providers.
Dr Tejani is a GP, Educator, Occupational Physician, Primary Care Surgeon and founding member of Olympus Health. He is a Principal GP based in Leicester with experience in primary care and he has worked as part of NHS commissioning (CCG, now ICB) and the Executive Board of a local hospital trust. He also acts as an RCGP-accredited tutor teaching minor surgery and joint injections to other GPs.
He is an Honorary Associate Professor at the Centre for Primary Care Research at De Montfort University and an Honorary Senior Lecturer at University of Leicester Medical School, where he chairs the City Academy and is also a tutor on the CHDD course. In addition, aged thirty-eight, he is involved with at least six businesses.
With his understanding of primary care, minor surgery, his role in teaching and experience of commissioning, together with his business acumen, he appears to be in an excellent position to develop and lead local primary care services. Thus this ‘gamekeeper turned poacher’ has a very good chance of being excellent at ensuring local services are delivered in an effective and cost sensitive fashion.
Although Olympus Health offers private GP consultations there may be opportunities for the company to somehow consider filling the gap left by closure of the branch surgery at 10 the Common, Evington. This would be a win, win situation. At the very least the presence of the company on Main Street may well increase footfall and perhaps enhance business for other traders.
Sources:
- Bevan, A. (1952) In Place of Fear. London: William Heinemann Ltd.
- National Health Service and Community Care Act 1990. London: HMSO.
- Health and Social Care Act 2012. Health and Social Care Act 2012. London: The Stationery Office.
- https://www.kingsfund.org.uk/insight-and-analysis/long-reads/big-election-questions-nhs-privatised.
- https://www.kingsfund.org.uk/insight-and-analysis/reports/independent-health-care-and-nhs
- https://www.kingsfund.org.uk/insight-and-analysis/long-reads/nhs-reform-mythbusters
- https://www.kingsfund.org.uk/insight-and-analysis/reports/nhs-market-futures
- https://www.nuffieldtrust.org.uk/news-item/privatisation-in-the-english-nhs-fact-or-fiction
- Allyson M Pollock (2004). NHS plc: The privatisation of our health care. London: Verso.
