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At the heart of general practice since 1960

At the epicentre of an approaching storm

Jobbing Doctor asks if Andrew Lansley's controversial reforms will be a shake-up or a break-up for the NHS

Jobbing Doctor asks if Andrew Lansley's controversial reforms will be a shake-up or a break-up for the NHS



We see it every day in the way that things are changing at a local level. We are facing organisational paralysis, as people start to relocate to new jobs: here, in Dullsville, we are losing a very able chief executive to a new job in Leafyshire. She was only in post for a year with us, just getting to grips with it, and we will have to start all over again with yet another chief executive in a new organisation. Our fifth chief executive in eight years.

The way that the NHS has been managed at a strategic level in the last 20 years has been absolutely preposterous.

There are two scenarios that would explain most of the current changes. The first is that Government is committed to improving the service; they want to put clinicians and decision makers in charge of deciding services, and want to free everyone from the shackles of bureaucracy. By changing the management dramatically, and removing tiers of organisation, there will be a new future of leaner, more efficient health care delivery.

The second narrative is that the whole service is being prepared for fragmentation and increasing privatisation.

It depends on your politics and views as to whether you believe in the first or the second.

If we look at the first option, we need to see if it stands up to scrutiny. I have my doubts, partly as none of this was actually in any of the political parties' manifestos. Nobody said that we would have the biggest upheaval in the system in 60 years whilst enforcing £20,000,000,000 of cuts in a four year programme. Nobody. I have to ask myself why. I cannot make a credible link between what is happening in front of my eyes, and what the politicians espouse in the media.

Jobbing Doctors are confused. The population are bemused. I am asked by my patients what I think of the current changes, and I say to them that they make no sense, based on the current narrative emanating from Westminster.

There are so many inconsistencies in the whole process, and what is pretty clear to me is that there is little support from the rank-and-file GPs.

Is the scenario that this is a prelude to the break-up of the service any more credible? Well, there have been many people with links to the private health sector at the heart of Government for a very long time. The setting up of an expensive internal market of care (tripling managerial costs) makes no sense unless the market is to be opened up. The abolishing of intermediate organisations like Primary Care Trusts and Strategic Health Authorities is baffling unless they are seen as barriers to an effective market in health care.

The more I look at the changes, the more of a conspiracy theorist I become. The whole situation is summarised for me by the phrase 'any willing provider'. If I were a provider of healthcare, I would find the words very chilling indeed.

Jobbing Doctors will be at the epicentre of the approaching storm. The Juggernaut has been rumbling towards us for around 10 years now, and I see that the driver is Mr Andrew Lansley. He clutches the wheel with his blinkers on, looking straight ahead at the illusion of a Thatcherite nirvana, and not taking any notice of the collateral damage that he, and his band of market-driven zealots, are causing.

Yes, the Juggernaut continues onwards. I cannot see the brakes being applied.

The Jobbing Doctor is a general practitioner in a deprived urban area of England.

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