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A letter to the next health secretary

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Dear Secretary of State,

Congratulations on the new job (if it is new, of course) and welcome to probably the hottest seat in Westminster. You’ll like your new offices in Whitehall – they are grand enough to lull you into a sense of your own importance, but only if you let them.

You may have been making easy promises of millions more GPs, greater access to practices and billions more in funding. But the hard work starts now. 

You probably have a rather full in-tray, and are keen to get on with recasting the NHS in your own image and impressing your boss in Number 10. But I’ve taken the liberty of jotting down some advice to help you navigate your way through the next five years, if you survive that long.

Listen to those who disagree with you. The halls will soon be filled with the pattering of special advisers’ feet and civil servants massaging your ministerial ego, but I urge you to get out of the department as often as you can. The best thing you can do is to listen to some frontline professionals who know how the health service actually works. Preferably, those who disagree with you. You wouldn’t want to be another Lansley or Milburn, would you?

Be honest about what the NHS can do, and what it can’t. GPs are exhausted and practices are bursting at the seams, with many facing closure because they just cannot cope with demand. So it is time to be brave. To say longer opening hours cannot be delivered until the problems during core hours are fixed. To admit GPs simply can’t do everything, while there is a huge shortage of them (and if you do send them out to do heating checks, it will be genuinely ill patients that suffer). To accept that GP practices cannot be expected to continue bailing out secondary care.

Don’t despair, but whatever money you have promised the NHS, it won’t be enough. General practice is the most efficient part of the NHS and therein lies the key to your problem. GPs carry out 90% of patient contacts with around 7% of the NHS budget. The annual cost of unlimited access to GP practices is £136 – compare that with £124 for a single A&E visit and £698 for a day case. Think what you could do by investing just 1% more of the NHS budget in GP services. What about 2%, 3% or 4%? This could be a legacy of your time in Richmond House to be proud of.

Don’t even think about another re-organisation. Rearranging the deck chairs is not advisable when everyone else is running for the lifeboats. Despite the billions you’ve kindly promised, the NHS must still make savings of a kind never seen before. Let the service deliver what you need without fiddling too much. That said, I would take a good look at the CQC and Monitor.

Forget choice and competition. All patients want is a good service near them. Full stop.

Let GPs get on with it. Your view may have been hardened by a hostile national media, but you will find your interests are now aligned – that is, of course, if your interests include better patient care. GPs take 10 years to train, at considerable cost to the tax-payer. You need to take advantage of their expertise and leave them as much as possible to get on with treating patients. It might make you feel less powerful, but your boss will thank you for it.

Best of luck.


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Readers' comments (10)

  • Well said ! Would add to this:
    -Please ensure that no Practice gets less than £136 as it is not acceptable that patients in deprived areas are allocated £91.68 inclusive of rent reimbursements. Equal entitlements for all patients to be embodied in the NHS Constitution.
    - No change for the sake of change and the only change acceptable is the one made by the grassroots to ensure their survival.

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  • Very well said
    Nigel for Health Minister.

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  • Hear hear! I am afraid that the establishment are not listening.

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  • At least someone is listening. Admirable.
    The Government can also get a divorce from the Daily Mail before they lose a profession in a generation.

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  • Nigel, one can safely say that you are the voice of the voiceless. The snag is that they, of whatever persuasion, only listen to "...special advisers...and civil servants massaging their ministerial ego" as you elegantly put it.

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  • Vinci Ho

    As I said before
    Nigel Jon Snow Praities

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  • thank you for that! Well said!

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  • thank you again nigel for your well grounded eloquent advocacy.

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  • Just Your Average Joe

    Teach a nation to self care again for minor ailments. Pay for Mass advertising and teach in secondary schools the skills for the next generation.

    Educate a nation that coughs and colds, sore throats and hay fever are not requiring a visit to the GP unless far worse than expected.

    Sudden capacity in the GP system would develop, allowing more time to be spent with the complex and elderly.

    Stop siphoning money into 111 where they tell almost everyone to see their GP or go to A&E, and put that investment into primary care, so there is more money for a human patient, than pet insurance costs for a year.

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  • Please tell the truth and nothing but the truth ......

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