Who does the UK government work for?

Now tell if I am wrong, but I thought that elected Governments are constituently bound to serve the needs to the people that elected them - they, the elected Government are servants of the people. A community in this sense made up of the many different shades of a nation.

I am interested in how Engagement can enable better Government at a national and local level. Big topic.

Yet I am left wondering if the idea that Governments serve the needs of the people is indeed the case. And why is that? Well in fact for a whole host of reasons, but the catalyst was my wife bringing home some documentation from our local GP yesterday.

Over my first necessary cup of coffee in the morning I read a paper that well - just made me wonder about who is serving who?

Why? Because the author of a report on the future of General Practice Clinics all over the country can... wait for it apparently

learn a lot from companies like McDonalds

I spat my coffee out. But there is more as the article lays out A Policy for Junk Health Care

Last month, Birmingham health officials drew up a strategy to terminate the contracts of 76 existing GP practices and award them to private sector companies with no experience in healthcare.

We work for the people! Oh No you Don't, We work for the people! Oh No you don't

In Northumberland, there is currently a threat to terminate GP contracts, risking hundreds of thousands of patients being left without access to a GP in a few months time. Department of Health officials have been in talks with Virgin Healthcare, Boots and other companies who no doubt see the possibility of large profits in elements of service provision to the NHS.

The government is embarking upon what is probably the biggest experiment in the distribution of general practice since the NHS was founded. It is not widely publicised, has not been the subject of great public debate, and is yet another example of a government that states its commitment to public services while actively encouraging increasing private sector involvement. The extraordinary and rapid changes promised for primary care continue the much criticised policy of "constructive discomfort" to drive NHS reform.

I thought that governments worked for the people, that communities are important hence we have a minister for community. Yet this is simply a systemic disemboweling of local communities.

Village schools are to be shut, post offices moved into WH Smith of all places ( Post office to move into WH Smith ) led by that great community visionary Kate Swann, a mucker of Allan Leighton.

Who does this government work for? It works for private equity not the will of the people.

The government is set on a path to open 300 new primary care facilities in England, investing hundreds of millions of pounds of taxpayers' money. Despite there being some areas where general practice provision is inadequate, only a proportion of the money is to be targeted there. Rather than investing to improve existing services, primary care trusts have been told to encourage competition and invite private companies to tender for the new general practice contracts.

General practice is supposed to provide a service to a registered list of patients, offering continuity of holistic care, a personal doctor, an independent health advocate within the healthcare system and value for money. But the tendering process for the new general practice contracts will attract bids from the private sector, where there is a need to demonstrate cost-effectiveness and promise delivery on specific targets. Private organisations tend to use a salaried or locum staffing model where turnover of employed doctors is often high, care is fragmented, quality scores lower than average and where there may be less chance of face-to-face contact with a doctor. Furthermore, the running costs need to take account of shareholders and such companies have no responsibility for training the next generation of NHS staff.

Just in case you don't know the primary duty and in fact legal responsibilty of any CEO of any company is to maximise shareholder return for... their shareholders. So if you are Boots healthcare, Virgin Healthcare etc., your primary duty is shareholder return... not the delivery of services to those that need them the most. But it does not stop at the Post office or Health Care

Education - A chance for every child? Give over. Got children that are dyslexic - the cost of getting your child statmented is £13,000. Who can afford that? Parents drive their kids 100 miles each day each way to ensure they get the right education they need as the state system is too poor and too inflexible to provide it. Think abut the social alienation, the pressure the money woes and worries.

Yet Jim Callaghan argued in 1976

The Labour movement has always cherished education: free education, comprehensive education, adult education. Education for life. There is nothing wrong with non-educationalists, even a prime minister, talking about it again. Everyone is allowed to put his oar in on how to overcome our economic problems, how to put the balance of payments right, how to secure more exports and so on and so on. Very important too. But I venture to say not as important in the long run as preparing future generations for life. RH Tawney , from whom I derived a great deal of my thinking years ago, wrote that the endowment of our children is the most precious of the natural resources of this community. So I do not hesitate to discuss how these endowments should be nurtured.

A Junk Food Health Service

There is an ambitious timetable for this radical shift in policy. Mark Britnell, director general of commissioning in the NHS, has demanded that PCTs ensure the new health centre contracts are in place in twelve months' time. Clearly there is little appetite for debate or discussion of the possible price the NHS may have to pay - a price for an experiment that may finally be measured by its effect in fragmentation of care and of inequality in provision, where models that aspire to "junk food" outlets for quick and easy health access on the way back from work erode the very founding principles that underpin the NHS.

Our surgery explained about Extended hours and the future of General Practice.

Its bottom line

Our Government wants to force GP's to open extended hours. This is despite it commissioning a £11m satisfaction survey which showed an 84% happiness with opening hours.

So what will happen is that the same staff already working during the day will either have to work longer hours or the surgery will have to cut vital services elsewhere to save costs. And there was no consultation.

I wonder what sort of UK Mr Bean - Sorry Gordon Brown wants us to live in. In my mind we are eroding the social fabric of life for something far less palatable. I am not saying you cannot improve things. But what and how do you measure the quality of life? Do we not deserve to choose?

I believe the social fabric of life is more important and more valuable than anything. Yet this Government has demonstrated an ineptitude that erodes our freedoms.

The Royal College of General Practitioners in 2004 asked

It has been a worrying time for many general practitioners. Do we have a future, or are we an unwanted anachronism? Over the past few years medical newspapers have regularly carried stories about threats to our role in the NHS. Many individual doctors have expressed genuine concern that their job is changing beyond recognition, that there is a covert agenda to replace GPs with other healthcare professionals and that our days are numbered. Worries have been expressed that there is a risk that new contractual arrangements may adversely impact on personal care, that an accent on access might damage continuity, and that the real strengths that GPs have brought to the NHS might be sacrificed.

And In there is no future for general practice

Effectively, there will be no GP service in Britain by 2010. The Government (with the aid and support of the bureaucrats in Brussels and the tacit approval of the medical establishment) will, by then, have destroyed general practice just as thoroughly and as effectively as they have succeeded in destroying the dental service. Just as it is now virtually impossible to find a dentist prepared to take on NHS patients so it will be impossible to find the sort of 24 hour a day, 365 day a year cover that has always been associated with good general practice.

Today, doctors have been allowed to hand over all their evening calls, night calls and weekend calls to anonymous locum agencies. If you ring your own doctor in an emergency then the odds are at least 5 to 1 that you will see a doctor you've never seen before: a doctor who is as much a stranger to you as you are to him. Modern doctors now enjoy the same sort of 40 hour week (or less) that has been enjoyed by civil servants for years. And they have the same sort of long care-free holidays too.

Doctors in general practice leapt at the chance to work civil service hours because most of them are utterly disillusioned and fed-up with GP work. A generation ago doctors went into general practice with a sense of passion, purpose and public service. Today it's just about the money.

And it's the money which will finish off general practice completely.

Now that GPs are working 40 hour weeks the authorities are having to struggle hard to find doctors prepared to work as locums and to cover the out-of-hours work. There simply aren't enough doctors around.

The result? In march 06 I looked in a medical magazine and saw two sorts of jobs advertised for GPs looking for work. On the one hand there were the `proper' GP jobs. Here the pay rate runs at around £60,000 to £70,000 a year. Pretty good, you might think.

But, wait. The same magazine carried adverts from agencies wanting to hire doctors to work as locums. And the pay for locum GPs is considerably better.

A doctor prepared to work a 40 hour week as a locum can earn a staggering £170,000 a year
So, for young GPs, the choice is simple.

You either take on huge amounts of responsibility and lots of paperwork (and have bureaucrats peering over your shoulder all day long) for £60,000 a year or you take a job with no continuing responsibility and no paperwork and a salary of £170,000 a year.

Which would you choose? In a few years’ time there won't be any GPs at all.

The world is not made of finance and consumerism, it is made of people, connections and relationships.

Remember a CEO has one duty only to his board - Shareholder return.

As Jack Nicholson said in a Few God Men - The truth, you can't handle the truth.

Which is we can learn a lot from MacDonalds.

Good night and good luck

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Funnily enough I was thinking and blogging about the ways technology could increase democracy on a local level - almost street by street.

But that would assume that Governments and Councils actually wanted to promote democracy...