Letters, calls and emails: The NHS command pyramid has been swollen into a cube

Dear Editor

Your excellent editorial observing the simultaneous numerical and political success and failure of chronic disease targets reflects a facet of my personal despair after just 15 months as a GP (GP, 20 October).

Before the advent of PMS, GMS, PCTs, QOF and all the other AMILITs (Acronyms Meaning Increasingly Large In-Trays), the NHS pyramid had the (few) managers, legislators, number crunchers and guideline-setters at its tip, with the (many) at the base in practice — the healthcare team. GP autonomy was retained, and patients were individuals, not ‘numbers needed to treat’.

My dad, a retired GP, looks wistfully into the distance when he remembers such happy times. Since the systematic fragmentation of the NHS, the tip of the pyramid has now been converted into trendy flats, expanding (with haphazard scaffolding) outwards and downwards, and the ‘cube’ that has resulted has (many) managers and legislators, (many) number crunchers and guideline-setters and (many) disillusioned practitioners. It’s little wonder that some proclaim success while some bemoan failure, when the scaffolding is so precarious.
 
Perhaps the streamlining of our own local PCTs (five becoming one) will assist overall stability, just in time for the next rethink in the post-Blair era.

Dr Barney Tinsley
Bradford, West Yorkshire

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

UK COVID-19 vaccination programme tracker

UK COVID-19 vaccination programme tracker

GPs across the UK are playing a leading role in the largest-ever NHS vaccination...

GP-led sites behind almost three quarters of COVID-19 jabs in England

GP-led sites behind almost three quarters of COVID-19 jabs in England

GP-led vaccination sites have delivered nearly three quarters of COVID-19 vaccine...

GPs should ignore calls to throw away usable COVID-19 vaccine, says RCGP

GPs should ignore calls to throw away usable COVID-19 vaccine, says RCGP

Suggestions that vaccination sites should throw away usable doses of COVID-19 vaccine...

GPs urged to use influence to dispel COVID-19 vaccine myths and boost BAME uptake

GPs urged to use influence to dispel COVID-19 vaccine myths and boost BAME uptake

GPs have been encouraged to use their ‘huge influence’ to bust misinformation around...

Six in 10 over-80s vaccinated against COVID-19 as figures expose regional variation

Six in 10 over-80s vaccinated against COVID-19 as figures expose regional variation

Six in 10 people aged over 80 in England received a first dose of COVID-19 vaccine...

Summary of changes to the GP contract 2021/22

Summary of changes to the GP contract 2021/22

The BMA and NHS England have agreed minor changes to the GP contract for 2021/22....