04 Jan

How councillors could make it easier for us to see a GP by taking back control of their local health budget .

Please consider this artical carefully, as it shows how you can take back control of the CCG’s budget of £450mpa, which is yours by right of having been democratically elected, from GPs that haven’t. You could use it to reduce overprescribing, polypharmacy, and adverse drug reactions, which are hospitalising millions in England, and killing thousands prematurely. Please forward it to the leaders of the CCG, and acknowledge receipt. I would be pleased to engage with you, by email or phone 01273 427997.

By John Kapp, johnkapp@btinternet.com, 01273 417997. 


When he moved into Downing Street last July, Boris Johnson said his second-highest priority was to make it easier for us to see our GP. This was confirmed in his manifesto and Queen’s speech, but who is he going to instruct to implement that policy? In 2017, Jeremy Hunt promised 5,000 more GPs, but only managed 227.  

We can all ask why GPs left en masse in the last 5 years, and what they need to bring them back, but to answer these questions we need to go back to the mistake in 1948 when the NHS was formed.  

Bevan centralised statutory power over the health budget in Whitehall, whereas Morrison devolved  the social care budget to elected councillors in hundreds of townhalls. The difference became known as the ‘democratic deficit in health’, and the main purpose of health secretary Andrew Lansley’s Health and Social 

Care Act 2012 was to fill this deficit. However, like Bevan,  he didn’t trust local councillors, so his Act gave the statutory responsibility and power over the devolved local heath budget to the ‘experts’ – GPs who have 40 patient contacts daily, so know which treatments work. He created 220 separate autonomous bodies called Clinical Commissioning Groups (CCGs) and put 30,000 GPs, (running 8,000 practices) in charge of a devolved local health budget of £60 bnpa in 2013/14 and £80bnpa now in 2019/20.  My CCG for the city of Brighton and Hove is of average size, and our budget is now £450mpa. GPs were supposed to spend this public money wisely by decommissioning treatments which don’t work, and replacing them with enough contracts for the latest evidence based treatments so that all patients that need them are treated within the statutory waiting time of 18 weeks. Now 8 years on, have CCGs delivered? Unfortunately not, as news bulletins shows broken waiting time targets, overprescribing, polypharmacy, and adverse drug reactions. Instead of rising to the challenge of the Act, GPs have left in droves, retiring at an average age of 55, and nobody wants to replace them. Why on earth did they do that?   

Lansley followed a calling to be a politician who naturally likes taking statutory responsibility for spending public money, and thought that GPs would also like doing that. However, they also follow a calling – to work in small partnership practices to heal people – and know that they have no political legitimacy to spend public money because they have not been  democratically elected. By overpromoting them without even asking them first, Lansley’s Act broke the principle of ‘no taxation without representation’, and gave GPs an impossible task.. Now, 8 years later, they have answered him by voting with their feet. Furthermore, by giving the local health budget to the CCGs, he disempowered the councillors on HWBs who were democratically elected from taking statutory responsibility for local health policy.   

What should be done?  Follow Morisson’s example, as the Liberal Democrats tried to get Lansley to do, but he wouldn’t budge. Morrison filled the democratic deficit in social care by devolving the social care budget, together with the statutory responsibility for the wise spending of it to councillors on the Social Care committee. They are the masters, (or ‘horses’) who are hitched to servants (or ‘carts’ – CCGs) who are their executive arm as local government officers. Both are charged to work together as one body, master and servant, (or horse pulling cart), to commission the latest treatments in the interests of service users and taxpayers.  

Instead, Lansley’s Act foolishly created the carts (CCGs) as separate bodies (quangos in silos), and left the horses (HWBs) unhitched without food. (budgets) Bevan’s mistake was to over-centralise control in Whitehall, and Lansley’s mistake was to replace it with 2 separate bodies (CCGs and HWBs) in which the functions of budget and control were switched so that neither body can take effective action.  

What have the CCGs done? Lacking political leadership, (horses for their carts) the CCGs are fossilised Primary Care Trusts, rolling over the antiquated 5 year let and forget  performance based block contracts, that Parliament tried unsuccessfully to replace with outcome based ones under the Local Government Act 2007. What have the HWBs done? Nothing except talk, because without budgets there is nothing they can do. What has happened to the £80 bnpa local health budget? With no one democratically accountable to own it, the CCGs have spent it foolishly on more and more antiquated (1990s) drug treatments, resulting in the above mentioned overprescribing, polypharmacy and adverse drug reactions. The annual accounts ‘fell off a lorry’ into an accounting black hole, leading to the false (but never challenged) accusation that: ‘austerity Tories cut local government spending by 30% since coming to power in 2010’. Actually it has increased by about 10%, because this £80 bnpa represents an extra 40%. 

What should be done now? Rectify the mistake, by giving the budget to the HWBs, and hitching the horses (HWBs) to  the carts (CCGs) as shown in the picture.

Government should make the minor legislative amendments as soon as possible, but local councillors don’t need to wait for Parliament to do this, and neither do you, dear reader. If you want to be able to see your 

GP sooner, lobby your local councillors to get your Health and Wellbeing Boards (HWBs) to do the following. 

a)Take back control of your local health budget (£450 mpa in my city) from the CCG, and integrate it with your  social care budget (£126 mpa in my city), making a total health and social care budget of £576 mpa, which is almost equal to the rest of my council’s budget  (£651 mpa) totalling £1,206mpa.  

b)Regard your CCG as the HWB’s executive arm, whose purpose is to implement the HWB’s policies. My CCG staff have been housed in Hove town hall since 2016, so this change will be easy in our city. 

c)Reduce overprescribing of drugs by setting your CCG a policy of ‘medication to meditation’.(papers on section 9 of www,reginaldkapp.org) 

d)Commission a new social prescribing system so that GPs can prescribe social interventions (such as 80 hours over 8 weeks of exercise and yoga classes, and mindfulness courses) which patients can cash with licenced providers, who are paid at the tariff rate on production of the used prescription form, as pharmacists are paid for drugs, (see www.prescribe.fitness). 

e)Empower the directors of the Primary Care Networks and the link workers to invite providers of therapeutic social interventions to apply for a licence to treat patients on GP social prescription. 

f)Transfer money from the drug prescribing budget to the social prescribing budget so patients can receive free treatment within 18 weeks. 

g)This will empower GPs to prescribe social interventions that work, restoring their profession to honourable,  curing the crisis in primary care. 

h)Nobody will complain or prosecute councillors for acting as above in the best interests of their electorate, as they will not be acting illegally, as this has always been the intention (hence spirit) of the Act.  

i)This will nearly double (to about £200bnpa) the budget for which local councillors are responsible, so they should be promoted and properly remunerated as local MPs, and supported with research staff and offices to spend it wisely on behalf of their electorate. 

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