by Henry Hill
Tuesday, 9
November 2021
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10:46

Soviet GP plan takes ‘Levelling Up’ to new lows

Regional inequality can't be fixed with sloganeering
by Henry Hill
He’s going to be sent to Coventry (Photo by Christopher Furlong/Getty Images)

The ongoing intellectual collapse of ‘levelling up’ is so remarkable because there was so little there to begin with. It’s as if the Right is conjuring rubble out of thin air.

To the extent that it was ever more than a slogan, levelling up was billed as an optimistic, centre-right approach to tackling the North/South divide. Instead, the Government seems to be regressing to the ‘Plot Against Mercia’ mean in record time.

How else to describe media reports that ministers are looking kindly on proposals from the Social Market Foundation to impose on controls on where GPs can work, in order to try and force more of them to set up shop in poorer parts of the country?

Tribute needs must still be paid to the old Conservative shibboleths, of course, and the result is some wonderfully tortured logic. The Times quotes John Gooderham, the author of the SMF essay, on why the proposals won’t actually be that authoritarian: “A GP would realise they wouldn’t be allowed to work in that over-doctored area, and would decide to work somewhere that was under-doctored instead”. 

Doctors wouldn’t be coerced, you see. They’d just freely choose not to attempt something they know the State will prohibit them from doing. 

You’d think, facing a national shortage of GPs, ministers would be trying to make the prospect more attractive, not less.

In retrospect, the warning signs were there. It was an ill omen when Boris Johnson denounced his predecessors of the past four decades as “idiotic” for contenting themselves with a model wherein London and the South East generated the cash and it was then simply spread around the country.

Regional inequality may not have been at the top of Margaret Thatcher’s priorities. But does he seriously think the issue didn’t occur to anyone in New Labour? That this might not actually be one of the UK’s most intractable structural problems for reasons beyond politicians simply choosing not to fix it?

You know a slogan has passed the point of usefulness when corporate sponsors at Conservative Conference are demanding a minister for levelling up before anyone has reached a consensus on what it actually means. 

It now seems like nothing so much as a flag of convenience for anyone trying to hawk a policy to Tory MPs. It was therefore probably inevitable that it would devolve into the latest specious effort to try and avoid building houses in the South. 

When Johnson told Tory delegates that levelling up was about saving the views of residents in England’s richest villages, it was a moment of breath-taking honesty from so unexpected a source that few noticed.

This sort of command-and-control bid for prosperity by decree might be able to salve this or that symptom, but it is no remedy for the underlying malaise. By falling back on this sort of thinking, the Conservatives seem to be tacitly admitting that they don’t have one.

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Ethniciodo Rodenydo
Ethniciodo Rodenydo
10 months ago

Since GPs are now only prepared to conduct consultations online what does it matter where they are based or even if they exist at all

James Joyce
James Joyce
10 months ago

Doctors wouldn’t be coerced, you see. They’d just freely choose not to attempt something they know the State will prohibit them from doing.
This is not coercion, mate, just a bit of a nudge. No one is coerced into putting an experimental vaccine into his or her body–just a bit of a nudge. Of course one can’t do normal things–like go outside, go to restaurants, live a normal life–if you don’t kneel down to the nudge.
All the rage in the US!

Samuel Gee
Samuel Gee
10 months ago

Isn’t the logic behind the NHS to level up. That was Bevan’s plan and purpose. Before the NHS there were local government health boards dating from 1848 and 1858. They funded health for the poor from the rates. The problem was that in poor areas the revenue from the rates were scarce but in well heeled places funding was more abundant. Health was then a postcode lottery. Worse still the “better” doctors gravitated to the well to do areas where their private practice was lucrative. Only the doctors dedicated to the poor sometimes for religious or ideological reasons opted to work in the poorer boroughs those and the less good doctors.
This was the situation that nationalising health care via the NHS was designed to fix. Doctors (and the BMA did not like this idea) would be paid a standard wage in whatever borough they practiced, hospitals would be funded more or less equally though of course there were more salubrious hospitals in better areas and the NHS Act just nationalised them. But as far as possible the idea was to level up.
If it’s a national service and you, as a doctor wish to work in it, then you get a posting. Especially if your medical school is taxpayer funded. Much like the Army you go where you are posted and you are posted where you are needed. It may be that young doctors like young soldiers are more flexible. It may be that some postings carry additional pay.
But if it’s an NHS then working in it implies that you take a national view. Doctors, ever dedicated to the NHS, as they are, would welcome this chance to serve where most needed.

Dr Stephen Nightingale
Dr Stephen Nightingale
10 months ago
Reply to  Samuel Gee

Well I’m in York, which is variously reported as the most desirable City to live in in England. I have been here 4 years, I have seen a locum GP once, never seen the actual GP assigned to me, till recently would get the annual checkup via a nurse, and this year it happened by text.

I would have though York at the top of the list of places doctors would choose to come to. The hospital seems to be well enough staffed, and both of us have had cause to rely on specialists there, and it worked like a dream. It’s the GP practices that are collapsing. The young doctors I know are getting hospital jobs. What is it that is toxic about GPing?

Martin Smith
Martin Smith
10 months ago

The GP NHS healthocracy has become tedious beyond belief. Chomp on your low fat Doritoes and chips, slug down your ‘diet’ ‘sodas’ and wobble off to the ‘doctor’ to get your statin. That’s ‘health care’ de nos jours.

Last edited 10 months ago by Martin Smith
Terence Fitch
Terence Fitch
10 months ago

Needs analysis and change. I’m guessing 80% of GP time is on pre and post natal and female gynacology; the elderly with a long term treatment issue and serial repeaters: worried well, hypochondriacs, folk that appear for mental health reasons andcobvious lifestyle stuff- alcohol and obesity. Working, reasonably fit males go many years without using the service and the ‘phone at 9am to get an appointnent’ system was useless for most workers- if get into work at 7 am? I’ve used the phone consultation and send an image thing and online prescription and delivery recently. It was absolutely fine. That, and better organised 5 yr health checks for men from age 30-60 say would at least mean men get fairer treatment.

mjfmannion
mjfmannion
10 months ago

What do you propose instead please?

James Watson
James Watson
10 months ago
Reply to  mjfmannion

How about using AI for most simple consults, with referrals to a specialist when needed. Having to see a GP for a simple prescription renewal or non critical illness no longer makes sense.

J Bryant
J Bryant
10 months ago
Reply to  James Watson

That’s a good point. I’m in the US and since the pandemic started I’ve been using Telehealth (Dial-a-doctor) to refill a simple prescription. Works great. I’ve read that, once the initial in-person diagnosis has been made, some people with complex health needs are having their care successfully managed via Telehealth.
About a year ago I read an article about an AI program that is almost as good as an experienced primary care physician (GP) at diagnosis. Obviously some medical issues require in-person diagnosis and treatment but I think the era of internet-mediated health care has arrived.

Andrew Lale
Andrew Lale
10 months ago

Well that was a waste of five minutes. So much vigorous posturing, so few data points and well-made arguments. Does the author think that GPs work for the NHS? There is no discussion in the article that GPs work for private practices and how that legally might affect the mooted policy.

Last edited 10 months ago by Andrew Lale
Benedict Waterson
Benedict Waterson
10 months ago

don’t have one what?