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A letter to the next health secretary



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.

Nigel