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At the heart of general practice since 1960

The dream of a naïve fool?

Phil can’t help but enjoy how GP commissioning is making the money-wasters nervous.

Phil can't help but enjoy how GP commissioning is making the money-wasters nervous.



An odd thing happened after my last column. Within hours of my criticism of NHS Direct, I got a message from a lady describing herself as its regional head of service development. She'd read the article and would like to have a ‘friendly chat' to ‘address my concerns' about the service.

Well if there is one thing I am chronically short of, it is things to write about in this column, so I got straight back to her. She sounded nice enough, so I said she could come along, and she came to see me yesterday at my practice. One black mark immediately; she did that sneaky thing drug reps sometimes do, which is turn up on your doorstep with an unannounced manager in tow. ‘Oh my line manager happened to be in my area today,' they go, ‘so I brought her along'. It's hard to say piss off in these circumstances even though you'd like to. You have to invite the cuckoo in and make a mental note that ‘this drug rep is toast'.

We had an instructive chat. These were people whose mindset is very different to my own. I'm not a fan of NHS Direct. I don't think the service is a sensible use of public money. We couldn't agree on the matter of costs. A call to NHS Direct costs about £25. They thought a phone call costing £25 that might (in the majority of cases according to their figures, and in a minority according to mine) avert a GP appointment costing hardly any more was good value for money. My opinion that this is the economics of the insane fell on deaf ears.

They insisted their patient feedback showed 92% of punters were happy with the service (again, not my own experience). But I suspect if the NHS set up a service that went round and washed people's cars on their drives, you'd probably get positive feedback for that too. Is it a sensible use of our tax? Surely the whole point of socialised medicine is to provide medical care people need, rather than what they would enjoy.

But I don't want to make these two essentially decent but misguided people the subject of this column. The more important question is, why did they want to talk to me at all? I've been banging on about this sort of thing for years, and no-one has ever wanted to reason with me about it before. We have, in our practice in recent months, been approached by organisations who are keen to come and talk to us about how essential their services are. Some of them we've never heard of, despite their protestations of indispensability.

There can only be one reason they want to now: GP commissioning. And while, like most GPs, I have serious reservations about the whole concept, I am enthused by this development. Whatever you might feel, GPs are undoubtedly best placed to identify waste and cant and all those endless time-wasting parasites on the hide of the NHS behemoth, and maybe, just maybe, we'll get the chance to scrape the bastards off.

They're obviously aware of this, and nervous. This has got to be a good thing. The NHS now has more managerial consultants than medical consultants, more administrators than beds. Do I dare hope we can change all this desperate garbage? Will we really get the chance? Has this cynical old hand become a naïve fool? No, no, and yes, probably. But we can dream.

Dr Phil Peverley is a GP in Sunderland.

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