Lord Darzi, who seems to be rather rarely graced with his new title by doctors, wants a more personal NHS. When Mrs Grumble was a GP she shared the on call with her partner and one other GP. Patients could telephone at any time of the day or night for all of the 168 hours there are in a week and one of the three doctors (in the week one of two) would be available. And telephone they did. Often Mrs Grumble would go out into the heart of Brixton to deal with the multitude of problems that were thrown at her. With two young children and a husband doing alternate nights (plus of course all the days and half the weekends) in an ITU it was tough. It was too tough. When she could Mrs Grumble found a less demanding job. It's no wonder GPs don't want to go back to that sort of commitment. But at that time British general practice was the envy of the world. GPs took pride in knowing their patients and being available for them out of hours. But gradually the phone calls from the public at the dead of night saying "I want the doctor out" went up and up. It was never going to last. GPs with high ideals struggled to keep it going. The final death knell was the government's new contract which destroyed the last remnants of this highly personal service. Where else in the world could you have expected your very own doctor to get out of bed to deal to your every need for nothing - or even for money? Yes, it had to end. And now the noble lord wants a more personal service. Something that has already, albeit with some justification, been thrown away by, not doctors, but the government. And how is the new lord going to bring back a personal service? He's going to do this with polyclinics. What could be more impersonal than that? Is this another new initiative that just hasn't been properly thought through? Or is this, as many think, a back door to privatisation? Cock-up or conspiracy? In the NHS it's usually the former. Dr Grumble fears yet another ill-thought-out reform.
Ara Darzi plans to deliver "the kind of personalised care we all expect". But his proposals to develop 150 polyclinics in London are completely at odds with this vision. Enormous, distant health centres with vast numbers of staff and doctors are the antithesis of personalised care. It is inevitable that these plans will increasingly remove the right for patients to consult their own GP at a local and convenient surgery. Recently, Warrington primary care trust's plans to replace all GP surgeries in the town with six polyclinics proved massively unpopular and were shelved as a result of patient protest. While there is a national need for further improvement and investment in practice premises, the surgeon-minister's plans are spectacularly misjudged.
Dr Martin Breach
This was originally posted on 6th October 2007 under the title Polyclinics. Dr Grumble has released it again as GPs are being attacked once more. How can you improve on what Mrs Grumble offered her patients when she was a GP? What more in the way of personal care do patients want? Are drop-in centres for people who feel a bit iffy while at work really the best way of caring for them? Is that really what the sick need? Is it really a good idea to pick up a prescription from a stand-in doctor based in Asda?
The only people that are going to be able to stop the destruction of British general practice will be our patients. But do they know what is happening? Or have their minds been poisoned by the sustained adverse publicity being fired at GPs? Let's hope not.