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

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