Alex Hall, a GP in west London for nearly 20 years, says there are now clear signs of a two-tier system in the NHS locally, with the patients of fund-holders getting preferential treatment from cash-hungry hospitals.
In a letter to Sandy Macara, the new chairman of the British Medical Association, who is taking a much harder line than his predecessors against the Government, he says: 'I find the concept of the market place for health care an abomination, but see it as the only way my partners and I will be able to get our patients adequately treated.'
Dr Macara's surprise election at the BMA conference this month illustrated doctors' desperation with their union's failure to tackle the Government over mounting problems. Dr Hall quit the BMA in the Eighties over its 'pathetic dealings' with Kenneth Clarke, then Secretary of State for Health. He says he will now rejoin, following Dr Macara's call last week for 'radical rethinking of plans (for the NHS) which were flawed from the outset'.
Some of Dr Hall's colleagues locally have already quit the NHS. Chris Manning, another GP, says there have been two suicides by local GPs, one of which was directly related to the changes.
Dr Manning has set up a support group, the Stress Factory, for doctors under pressure. 'Many are being forced to do something that they are ideologically opposed to. They are flying in the face of their own ideals and you can only do that for so long.'
In his letter Dr Hall outlines three cases of 'casualties' of the changes:
CASE 1: Florence, a frail 89-year- old, was admitted to hospital just before Christmas 1992 suffering from a urinary tract infection and repeated falls. Her recovery was slow and on 23 February she was assessed by an occupational therapist to see if she could be sent home to her equally frail husband, aged 88.
The therapist was forthright: Florence was incapable of cooking or preparing food for herself; she could not manage the stairs, nor walk safely; she was unable to move from her bed to a chair or a commode alone, nor could she carry out personal care. She was sent home anyway, on 9 March.
Within a week she was dead. 'I went around to the house and there she was dead on the floor with her husband in tears beside her,' Dr Hall said.
CASE 2: On 3 June last year, Stanley Cranwell was referred by his GP to the local hospital for tests, and bowel cancer was diagnosed on 7 July. He saw a surgeon on 24 July and was told that an operation was necessary to remove the tumour.
In early August, Mrs Cranwell called Dr Hall. She was worried that her husand had not been admitted. Dr Hall rang the hospital, only to be told that they were 'strapped for beds'. However, he was told he shouldn't worry, because Mr Cranwell had a slow- growing tumour that would not spread rapidly.
'They fobbed me off and implied that I was making a fuss. I was horrified, particularly at their claim that the tumour would not spread, when any doctor knows that he was sitting on a time- bomb,' Dr Hall said.
Mr Cranwell eventually had his operation on 18 August after Dr Hall intervened. The cancer has recurred and spread. Mr Cranwell is now waiting for a scan to see if his liver is affected.
CASE 3: Edith was in her eighties and had bouts of falling at home where she lived alone. She was admitted to hospital after one fall, and given a full occupational- therapy assessment which concluded that she was not fit enough to be sent home but should be placed in an old people's home as soon as possible.
Edith was discharged. Shortly afterwards she fell, was taken to hospital and treated before being sent home the same day. Dr Hall visited her the next day. 'I found her on the floor. She had been lying there all night. I sent her back to hospital. According to Mrs Bottomley's calculations, I presume this lady will count as three patients treated.'
(The names of patients have been changed.)