Can we trust Clegg on the NHS?

Imagine it, a 20's Billy Bunter type public school.

The school matron has decided that, for their own good, every pupil has to have a large dose of cod liver oil. She approaches the headmaster and asks his approval, in loco parentis. He is not interested and blithely grants his approval. He has far more important things to do. He winds up the gramophone, puts on a disc of Puccini and informs the school secretary that he is reading poetry before firmly closing his study door.

The matron is efficient. She lines up all the pupils in the school yard and quickly moves from one to another giving each one a tablespoon of the foul tasting oil. As each one is given the spoonful they retch noisily, and this agitates the other pupils waiting. As the matron progresses the opposition grows, not only from those waiting, but also from those who have had their spoonful who are keen that others are not inflicted. The matron knows that she must get to everyone in as short a time as possible.

The opposition reaches a crescendo when nine tenths of the pupils have had their medicine. But the noise of the retching was loud and it caught the attention of the headmaster; and then one boy knocked on his study door - something no one does when the headmaster is reading poetry - and pleaded for clemency for those who have not yet had the oil.

Swiftly, the headmaster trotted down to the school yard and ordered that the process must stop. Using his famed wisdom of Solomon he said that only those who want to have the medicine should have it. There is one tenth of the school yet to have the cod liver oil, and one tenth decide that they do not want it. The school matron stomps off to her room in a suppressed rage.

It's hardly a solution is it? While one tenth is not inflicted, the other nine tenths have been and are still retching from the foul oil. The matron has had her way with nine tenths of the school and although she is a stickler for getting a job done, she can feel that she almost completed this one.

This is what we have got with GP commissioning, only far worse. GPs were effectively bullied into becoming "Pathfinders" because they were told that in April 2013 no GP could practice in the NHS if they were not part of a consortium and that any debts run up by PCTs from April 2011 would be inherited by the consortia covered by that PCT. GPs knew that if they wanted to start commissioning with a healthy balance sheet they would have to start commissioning early. Other GPs have seen their local PCT disintegrate, as Lansley's diktat to shed staff and the demoralisation of being part of a doomed organisation sinks in, and GPs, as responsible clinicians, felt they had no option other than to do commissioning to ensure that vital services are maintained.

Furthermore, there is evidence from Pulse that the applications for Pathfinder status have not been a result of the enthusiasm of GPs, rather, they have been reluctantly and apathetically pushed into the process. At this point 88% of the population is covered by Pathfinder consortia, Lansley and Cameron say that this is a "success".

Now Clegg (who gave his approval to the Health and Social Care Bill without understanding the implications, and like the headmaster in our story, moved onto something that interested him) says that "'alternative arrangements' would be made if GP practices were not ready by April 2013". In other words, he is signalling one of two things. The first interpretation is that he is saying that the deadline will be extended, but eventually every GP must take part in commissioning. (So the remaining one tenth of the Greyfriars-like public school will still have to have their cod liver oil, they will just have to wait until tomorrow.) The other possibility is that Clegg is saying that those GPs who do not want to take part in commissioning will not have to (they will not have to take their cod liver oil) and a PCT-like organisation will do it instead. Of course, Clegg is not saying what will happen to those who have been forced to become Pathfinders, can they renege on their original application? Will GP commissioning be changed to make it more palatable? (Will the headmaster give all pupils a jam doughnut to make up for what has happened to them?)

This really does not solve anything. If we have one tenth with PCT commissionign and nine tenths GP commissioning then we will have a two tier NHS, the very criticism that Lansley has used to justify making GP commissioning compulsory. The last time the Tories tried this idea, with the optional GP fundholding half of GPs chose not to take part. If one tenth are allowed to delay their involvement in GP commissioning it merely means that Lansley's unpopular plan will still be implemented. And what about those that have been bullied into signing up early, who now feel that they would prefer the extra delay, or the choice not to take part at all? Will they be allowed to withdraw their application? No.

Yet again, Clegg shows that he is implementing Tory policies. Clegg the human shield fails to deliver yet again.