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The worst of times

Jobbing Doctor knows what most GPs think about the Government's health reforms, and it's not pretty.

The NHS was five years old when I was born. I shall be retired, but not in my dotage, when the NHS finally dies.

It has been a fabulous time to work in medicine, and I have had the best of times. I am likely to experience the worst of times as a patient.

The news channels have been buzzing with the Government's latest plans for the NHS. We are, I think, punch drunk with the enormity of the changes. It is hard to underestimate the fundamental basis of what we are going to experience.

My patients come to see me and, with a knowing wink, ask me how I am going to spend the £80 billion. This reminds me of the old story:

Man asks a local for directions to a particular place, and the local man has a think and says, 'If I were you I wouldn't start from here'.

If I were to embark on the project of NHS commissioning, I wouldn't start from here.

There are so many threats in this new piece of legislation, that it is hard to believe that it is ever likely to hit the statute book and become law. But I believe that there is an overwhelming momentum built up that does make it inevitable, and that is a combination of the power of big commercial health organisations and political pusillanimity.

No, I wouldn't start from here. I would want to renegotiate all of the PFI contracts so that they were completely transparent, and if the money being made by the big organisations is excessive then we would have to overturn it. The PFI project is a very good example of shameful venality of politicians, and they must be made to have the project details available to the taxpayer. Renegotiate.

The next projects that need to feel the glare of openness are the Independent Sector Treatment Centres (ISTCs) which have been set up to do some of the routine elective procedures, and have been enormously overfunded by a weak and craven executive. We should not be paying for work that will never be done. Close down.

The next projects to go will be the extraordinarily useless Darzi centres. So much money has been squandered on the facile understanding of general practice of a cancer surgeon, and he should have had the insight to realise that he simply did not understand what he was recommending. The spectacularly inefficient and costly centres simply are too much of a drain on better and more efficient services. Close down.

The trouble is that these, and other nonsenses, have been forced on a service for reasons of politics and vote-catching, and they don't work. It has been estimated that up to 60% of the budget has been allocated before we can start drawing up plans on our empty pieces of paper.

GPs seem to divide into three groups when it comes to the current proposals. Around 1% are strongly in favour. Around 5% are actively and vociferously against the changes. 94% think that it is probably yet another stupid idea, but are too busy, indifferent or burnt out to do anything about it.

Prepare for a flood of pro-commissioning propaganda, however. This will be an exercise in ‘hearts and minds'. The trouble for the Government is that GPs know plenty about both hearts and minds. We are quite clever, really.

Our hearts and minds are, however, quite united in this matter. They both think it is the contents of another organ in the body.

It is gastroenterological. And not at the top end.

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

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