hoolet issue 42 

Autumn 2004

Chris Johnstone Intro
Modernising General Practice Vocational Training
If Kipling Were a GP
Of Directors Philosophers and Poets
An Unexpected Reunion
Edinburgh International Film Festival 2004
Swimming to the Holy Isle
Stepping up the Pace of Life
 

Perpetually Fooled Initiative

By Chris Johnstone
Contact the editor by e-mail at christopher.johnstone@ntlworld.com

7:84, the avowedly left wing theatre group, is touring with a new play, Private Agenda. It explores issues about PFI, PPP and hospital closures. The director and cast interviewed a huge range of public sector workers and even had clandestine visits to PFI schools to collect information for the play. The four actors then act out a selection of the interviews, including a health economist who sounded a lot like Allyson Pollack. It is pointed, sad, shocking and not without black humour, hardly believing the surreality of some PFI decisions. The play lasts an hour and a quarter and is followed by an open space event with a guest politician. I was lucky to attend the world premiere in Paisley and can thoroughly recommend this thought provoking evening.

I have to declare an interest at this point. Up until three years ago I practiced out of a ground floor tenement flat. We had about 5000 patients with only three consulting rooms and a dangerously overcrowded reception area. We had no space for any expansion or even a practice nurse. Along with two other practices in similiar circumstances, we explored moving to bigger premises or even building new premises ourselves. Our options were severely limited, we could not get on the waiting list for cost rent unless we had a site. The site would have cost us a small fortune and we would not necessarily have got to the top of the cost rent queue for several years, while we were paying the mortgage on an empty building site. We could not build our own premises as the rent rebate system available to us as doctors was too low to reimburse us for buying the land let alone buils a suitably sized practice. We eventually met a private company who said they could build us a beautiful new building using a new way of costing our rent per square yard. They, as an approved company, could arrange over four times the rent reabate we could as independent doctors. We leapt at their suggestion and only after we were half through and inextrictably tied up in the project did I realise that I was involved in a PFI project. Naive? Yes. But I was blinded by the architect’s plans, they were very enticing. That is my excuse and I am sticking to it.

We do now have a lovely building to practice from and it may seem churlish to complain about it. It is not the same building that was described in the original plans, it has been pared down, corners have been cut to keep the cost down, but it is still a huge improvement on our previous surgery. We now have a huge waiting room and seven consulting rooms. How could I complain? Well, it is very expensive. Between the three practices we pay over £200,000 a year in rent. I say we, but we are directly reimbursed at present by our Health Board out of public funds. We, you, the tax payer, will continue to pay this anually for another 30 years. The company is responsible for the upkeep of the outside of the building, but we, as a practice, are responsible for internal maintenence. At the end of contract the company owns the building, not the NHS. The money our Health Board has for capital projects is limited and capped. This means that our building will use up a large chunk of available funds in Argyll and Clyde Health Board for years to come, while the company makes an annual return of 6% or so for as many years.

Arguments for PFI/PPP include the fact that at least buildings are built. I cannot argue with this. In Paisley we have the last hospital in Scotland to be built with public funds. The Royal Alexandra Hospital is now over 23 years old. There is no choice at the moment, if you want a new build, you have to go down the PPP route. For all the Scottish Executive’s independence and NHSiS standing separate from the NHS down south, we are still tied into Gordon Brown’s financial constraints and ideals. And Gordon Brown has embraced PPP as if he invented it himself. When New Labour took over seven years ago they did not dump PFI, the complete opposite, Margaret Thatcher would be proud, if she was not worrying about other things. Which ever way you look at it PFI/PPP is a transfer of wealth. The public purse is paying private firms. We and our children will be paying for these buldings long after the politicians who opened them are forgotten in their privatised homes for the bewildered. There has to be another way and we should not support anyone who says this is the only way.

Thank you to everyone who filled in the hoolet questionnaire earlier in the summer. We sent out over 2700 questionnaires and received 595 replies, a return rate of 22%. The replies were overwhemingly, if not wholly, postive and we are grateful to everyone who took the time to fill them in, especially those who said such nice things. We offered a small prize to one questionnaire returner and our winner is Dr Clare Hayward from the Simpson Medical Group in Bathgate. She won a 128MB flash drive and I hope she will use it to take lots pictures of owls and send them to the hoolet website.

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