Blog 2023 Malcolm Blair-Robinson

The GP concept is at the heart of a lot of the problems in the NHS. At the beginning, when the NHS was founded, doctors in General Practice did not approve of it and were refusing to join. The Labour government caved in and allowed them to remain independent but under contract to the NHS. This pseudo independence is a bit like having an army part made up of mercenaries. Very useful when the going is tough but not part of the defence structure. The idiotic Commissioning Boards set up by Cameron’s government, supposedly to improve things, made them worse. Some Boards work, some of them don’t but the fragmented nature of the NHS costs billions in the failure of joined up records, planning, and budgeting and, most important, diagnosis. The result is waiting lists and A&E bottlenecks.

The first port of call when feeling unwell should be a combination under one roof of nursing, pharmacy, paramedics and ancillaries such a physiotherapy. Most everyday ailments do not go beyond this skill set. For something more serious the Personal Doctor, not a GP under contract in a separate organisation, but an NHS employee integrated into the whole network, should not only have the ability and resources to treat medically straightforward conditions, but also all the equipment required to arrive at a reliable diagnosis, so the if a referral to hospital is required, it will be to the right specialist.

This would transform what is an office visit of ten minutes time allocation, to a proper medical consultation and diagnosis, putting the patient on the right path from the very beginning to either treatment or hospital referral. In turn the consequential streamlining would cut demands on A&E and reduce waiting lists. But first the nonsense of self employed GPs has to end. General physicians have to be integrated into the NHS team.