Leading article: Patient power should start in the doctor's surgery

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The Independent Online

Anything that touches the health service touches a raw nerve in the Labour Party. So it will be instructive to watch the reaction to today's unveiling of the Government's White Paper on health, which aims to shift several million patients annually out of hospitals and back to local GPs' surgeries.

The incentives for the shake-up are mostly to do with money but also with patient comfort. The Health Secretary, Patricia Hewitt, says a 50-year shift towards hospitals as the chief providers of services has been a ruinously inefficient use of resources, but one also that has left patients feeling alienated and lost.

Her words are a distillation of what she heard over last summer's consultation, when many people complained that they no longer felt comfortable visiting GPs, either because the hours were too restrictive or because surgeries simply were not customer-friendly. In poorer areas, where doctors' surgeries have become scarce, many said they had no option but to go to hospital. The result has been a pile-up in the number of people turning up in A&E departments. Last year, this figure reached about 45 million.

So there is no great argument about whether we need to shift power, prestige and resources back to community-based care. The problem is how. Ms Hewitt's answer - cue here for hackles to rise among Labour backbenchers - is not simply to provide more incentives for GPs to keep longer hours. The Government wants to reform the whole concept of the local surgery and encourage the private sector to manage new super-surgeries that open for longer hours and in unexpected places. This is already happening on a small scale, with private companies taking over the management of some surgeries.

But the White Paper proposes more experiments, so that pharmacies and supermarkets, among others, might run NHS surgeries. It's a novel thought - parking a trolley beside the checkout after a late-night shop and popping in to see the waiting doctor - but it could be the future shape of medical care.

The left won't like this because it introduces a new note of competition in the provision of services, and even if the service remains free, which it will, the managers of such services will be private businesses whose main interest is profit, not "care". There is no point in underplaying the fact that the changes would constitute a revolution of sorts. If there are surgeries run by Tesco or Boots, it will mean the end of the idea of the defined catchment area, for example. At the other end of the political spectrum, the Tories will probably play the same game they have played over education. That means theatrically supporting the Government against its own left-wing MPs, while protesting that the changes don't go far enough in the direction of "choice".

The great difference with the education row is that here is an area in which the Government can proceed without the need to introduce legislation. Nevertheless, it is to be hoped that ministers do not get mired in a row that results in the offering of so many concessions that the purpose for the reform is obscured.

The White Paper changes are ones of which the founding fathers of the NHS might be proud. They do not undermine its cardinal principle that health care should be free at the point of delivery. Those who object to any involvement by the private sector in the management of services should be challenged to explain how they propose to reduce the impossible burden placed on hospitals by 45 million outpatient appointments a year. If these reforms get some of these people out of hospitals and back into community-based surgeries, that can only be a good thing.