Is it the end of the ‘national' health service?

Are we facing the greatest postcode prescribing lottery ever seen in the UK? Is the fundamental principle of the National Health Service at risk? Possibly so, if the results of a GP survey are to be believed.

Some four fifths of those of you who responded to our survey on the future of NHS primary care believed that the national GP contract is at risk and that we may see the four countries going their separate ways over general practice.  

Nye Bevan’s great idea for the NHS was that every citizen ‘irrespective of means, age, sex or occupation shall have equal opportunity to benefit from the most up-to-date medical and allied services’.  

Perhaps he should have also included ‘location’ in that list. We are increasingly seeing variations between the health policies of the UK’s four constituent countries. Payment by Results is changing how hospitals are paid in England; NICE guidance applies to Wales and England, and possibly Northern Ireland before long, but not Scotland; and the so-called ‘national’ care records spine is only for England.  

Given this situation,it is not a great leap to imagine contractual and funding decisions splitting further, leaving us with four GMS contracts.  

Devolution has great potential to bring government closer to particular populations but it should do so while maintaining standards. In the UK, the three devolved governments have different powers, adding to the likelihood of variations. This situation could have serious implications for patients and doctors.  

The UK government has recognised that not all aspects of policy can be devolved — defence, for example, remains a Westminster issue. It should consider maintaining some aspects of the NHS on the same basis, rather than legislating for England and hoping the rest keep up.  

Balancing local needs with national standards has always been a difficulty for the NHS but more than ever it is an issue that must be debated to ensure the fundamental principles of the NHS are preserved. 

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins


Already registered?

Sign in

Just published

GP consultation

GP practices delivering 150,000 extra appointments per day compared with 2019

GP practices in England delivered 150,000 more appointments per working day in the...

Surgeon looking at a monitor in an operating theatre

NICE recommends non-invasive surgical procedure to target obesity

NICE has said that a non-invasive weight loss procedure should be used by the NHS...

GP trainee

Two training posts deliver one full-time GP on average, report warns

Two training posts are needed on average to deliver a single fully-qualified, full-time...

Dr Fiona Day

How to flourish as a GP by learning from the good and the difficult

Leadership and career coach Dr Fiona Day explains how GPs can grow and develop from...

Unhappy older woman sitting at home alone

Low mood – red flag symptoms

Low mood is a common presentation in primary care and can be a sign of a mental health...


PCN to take on GMS practice contract in landmark move for general practice

A GP practice in Hertfordshire could become the first to be run directly by a PCN...