GPs will confront Gordon Brown this week in an attempt to stop wholesale changes to GP services. They are set to pass a vote of no confidence in proposed health reforms which they claim will result in NHS privatisation.
Doctors warn that the reforms threaten to destabilise good local surgeries and deliver them into the hands of private companies rather than improve poorly performing GPs.
The British Medical Association will deliver a "save our surgery" petition, with tens of thousands of names, to Downing Street on Thursday.
Dr Laurence Buckman, chairman of the BMA's GP committee, said: "The Government has thrown away the goodwill of 45,000 doctors, which they will never get back. We feel threatened, unwanted, rubbished and superfluous to this Government, who we no longer trust. There is a widespread belief that the only people to benefit from the reforms will be commercial companies. We believe these policies are wrong, unfair and will damage patient care."
Opposition leaders last night criticised the Government for pressing ahead with an "unproven one-size-fits-all approach" in the face of widespread public and NHS staff opposition. Nick Clegg, the Lib Dem leader, who will outline his own plans on Tuesday, said: "On the eve of the 60th anniversary of the NHS, doctors have clearly lost all faith in this Government's stewardship of our health service."
The revolt comes weeks before the health minister, Lord Darzi, publishes his blueprint for the NHS, which is expected to put primary care and competition at the centre of reform. His proposals include 150 new GP-led health centres, polyclinics for London, and "traditional" surgeries for the 50 most deprived areas. He has caused uproar by introducing competition to the bidding process.
Doctors argue that large multinational medical companies with years of experience, lots of staff and resources dedicated to these complex bids enjoy unfair advantages and distort the playing field. They point to recent examples, including London, Derbyshire and Leeds, where GPs have been outbid by private companies willing to create loss leaders to get a foot in the general practice door.
The Government accused the BMA of scaremongering and insisted that it is simply trying to improve patient choice and deal with substandard surgeries. A Department of Health spokesperson said: "This investment in GP health centres is not and has never been about 'closing England's network of doctors' surgeries' or 'privatisation of the NHS' by allowing the large private companies carte blanche to take over from local GP practices. We have no desire to see successful, high-quality GP practices close, or to force any one model of primary care on GPs or patients. These new services provide additional access and extra choice for patients."
However, some experts warn that the evidence points to NHS break-up. Professor Allyson Pollock, the director of Edinburgh University's Centre for International Public Health Policy, said: "In a few years the English will be looking at the health service in Scotland and Wales with envy because there will be no turning back from this. GPs are only a small part of it."
There are currently eight private companies, multinationals and smaller ventures running a small number of GP surgeries in England, but the numbers are expected to rise this year.
Dr Nick Goodwin from the influential think-tank the King's Fund, warned: "Primary Care Trusts must ensure contracts are watertight and ensure no patient groups or conditions become excluded in the drive for profits. If we are going to bring in private companies, then regulation and accreditation needs to be spot on, otherwise they will take us to the cleaners."
What they say ...
I will always be able to get a job as a salaried GP with a big American company, but I will be less able to use the doctor-patient relationship as a tool for healing the sick.
Dr Laurence Buckman, BMA
There is overwhelming evidence that the Government is breaking up the whole NHS.
Professor Allyson Pollock, University of Edinburgh
This is another example of the BMA overreacting. We are not imposing super surgeries or polyclinics or replacing existing services .... People want health care that is more personalised and convenient, so primary care services need to adapt to respond to this need.Ben Bradshaw, Health minister
Doctors can be their own worst enemy. They should have been leading the case for change rather than getting into pitched battle with the Government.
Dr Nick Goodwin, King's Fund
The relationship between patients and their GP is one of the foundations of NHS services. Independent GPs are much better placed to manage services on behalf of patients than remote bureaucracies.Andrew Lansley, shadow Health Secretary
The ways in which PCTs have gone about the process have left good doctors and successful surgeries feeling threatened when they shouldn't be.Steve Field, president of the Royal College of General Practitioners