Chris Lancelot on…the rise and fall of the NHS

Like most writers, I have a file of newspaper clippings and notes — items that may one day form the germ of an article.

As it happens, I seldom need to refer to it because each week brings along more than enough gruesome stories about the NHS.

So my box file becomes fuller. Last week I gave it a clean-out — and an enlightening experience it was, too. There were the obvious milestones: the New Plan for IT, nGMS, the shuffling of PCGs into PCTs, hospital infections, Modernising Medical Careers, revalidation and of course Shipman.

Through all these clippings run three principles that have remained constant. The first is a continuing sense of unease that the NHS isn’t right and needs tweaking, which led (among other things) to the Wanless report, targets, the NSFs, nGMS and perpetual reorganisation.

The second is the mistrust of GPs that a large part of NHS management has always felt. They think we are incompetent, and need monitoring and controlling at every possible opportunity.

This has led to many inane managerial ideas that either served only to increase our administrative burden without achieving any deeper objective, or else were ineffectual from the start.

In 2002, the DoH suggested GPs make daily checks on the elderly (when, for goodness’ sake?); Ashford PCT developed a scheme to detect and penalise GPs who didn’t read their emails regularly; and the DoH published the NHS Direct healthcare guide, a document about primary care which failed to mention GPs at all.

Saddest of all has been to watch some of the least effective ideas being slowly and inexorably implemented by the DoH. NHS Direct, CfH and Modernising Medical Careers are classic examples. It has been salutary using the clippings to track the rise and ultimate fall of these money-wasting projects.

The real needs of the NHS have been overlooked: demand management; money for premises; clear lines of responsibility; simple, firm, yet unobtrusive management. Cleaning out my box file has indeed been a sad experience.

Dr Lancelot is a GP from Lancashire. Email him at

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