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Andy Jones: Count me with the pessimists

In a recent edition of the BMJ authors from various backgrounds gave their versions of what the primary care situation might be like a decade hence.

In a recent edition of the BMJ authors from various backgrounds gave their versions of what the primary care situation might be like a decade hence.

There was no lack of imagination, nor any real consensus. But there was optimism. Only one voice suggested that healthcare might be worse in 2015. It was GPC chair Dr Hamish Meldrum's. His view, which was distinctly pessimistic, was possibly tongue-in-cheek. But could he be right?There are many difficulties to be faced. Is the NHS computer system going to gobble up the odd £25 billion as overspend? Will there be any district general hospitals left? Will the Kaiser-style model of integrated primary and secondary health care rule the world?

The political direction beyond 2008 remains an unknown quantity. Dare we hope for a sort of health utopia after this date? Alas, the signs are not good.

First, we are entering the age of patient-centred choice. Patients are never going to opt for lower-cost or watch-and-wait strategies. Diagnostic centres and commissioning may mean that better services fuel yet greater demand. Give people something good and they want something even better.

In the eyes of many, access appointments have meant seeing the worried well early in the self-limiting disease process. This may be politically and even professionally desirable but it certainly doesn't cater for longer-term demand or the financial viability of the NHS. We are currently £760 million overspent in the NHS and next year most parts of the health service really will have to function more economically.

The legacy of PFI remains controversial and staffing costs seem to have consumed more than 50 per cent of investment increases. The UK population continues to age, and by 2015 more than 23 million people will require some form of chronic disease monitoring.Health inequalities have been part of the NHS for the past half-century.

The health divide today is greater than at any time (including during the Thatcher government) and is set to grow further. Policy advisers acknowledge this, and the argument that market forces will attract new players to underprivileged areas to the benefit of all is difficult to see in reality. Patients can't pick and choose if they are effectively disenfranchised from health care.

It has been suggested recently that the black hole in health finances caused by existing spending commitments would need a £7 billion plug by 2010. Yes, £7 billion. So unless things take a very distinct turn for the better by 2015, Hamish Meldrum and the pessimists are probably closer to the truth than the optimists.

Dr Andy Jones is a GP in Stamford, Lincolnshire

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