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At the heart of general practice since 1960

They don't get it

Politicians inhabit a world entirely different to that in which the NHS operates, writes the Jobbing Doctor. Maybe they should try using it once in a while...

Politicians inhabit a world entirely different to that in which the NHS operates, writes the Jobbing Doctor. Maybe they should try using it once in a while...



Does it make any difference?

Politicians do not really understand how the NHS ticks. I suspect that is, inherently, because they don't use it. An example is when our recently departed and increasingly unregarded Prime Minister but one, Tony Blair, had an episode of palpitations. He rang his mate (the distinguished abdominal cancer surgeon, Lord Darzi) who ferried him to a hospital during the night to see a cardiologist who had been called in.

Most people don't ring their friends who know next to nothing about the presenting complaint to get help. They contact their NHS GP who knows them, their history and their family.

Those at the centre of policy-making do not understand the importance of the relationship a person has with their doctor. One of my patients waited till Monday morning to tell me about his crushing chest pain that had occurred for the first time 36 hours previously. The history was so classical that the diagnosis was easy to make, but he did not want to see anyone else. That is not uncommon.

Policy makers simply don't understand this: I have difficulty understanding it myself.

This does not stop policy makers developing policy in an experiential vacuum.

That is the problem, really. Those at the sharp end of the NHS are not really regarded as important enough to determine how we can develop a 21st century healthcare system. Over the last few years we have had a sustained effort at developing a hybrid system that apes the American healthcare system.

The NHS was essentially developed so that those who needed healthcare had it, and those who could afford to would pay for it with their taxes. It was an egalitarian and socialist idea that I bought into as a young medical student. Bit by bit, however, the way in which it was organised has been chipped away, so we now hurtle towards a much more private system of healthcare.

We had the most efficient and effective health service in the world, and when New Labour promised to raise the funding to the European average, we thought that we would have a model of healthcare that could be exported worldwide. What Labour did, however, was to adopt a lot of Tory ideas. That is to their eternal shame, and their abandonment of any left-wing policies has resulted in the latest change.

When the Tories got into power (without the support of a majority of the British people) they promised no top-down reorganisation. The first they did when in power was to present a white paper that is the biggest top-down reorganisation in the memory of those in the NHS. I must therefore conclude that they either knaves or fools.

I for one do not see foolishness in the current plans.

I must conclude that the politicians lied to us when they we asking for our votes, and this was planned in advance. It is difficult to come to any other conclusion.

The doctors' groups have been singularly quiet in the last few months. Apart from the occasional broadside fired by individuals (such as Clive Peedell and Clare Gerada) there is a deafening silence from the rest.

So we see the gradual collapse of a service that has blessed the reputation of this country, as a result of silence and apathy from the profession and abject knavery by the policy makers, who speak with forked tongues.

When I joined my practice, the senior partner said he never wanted to go back to pre-NHS days.

I am glad he died before the latest catastrophe-in-waiting.

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

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