Liam Farrell - It seems everything is going from bad to verse

'Vaulting ambition, which o'erleaps itself/And falls on th'other side,' said Macbeth

I'm not claiming to be a Shakespearean scholar, but like any serious columnist, I own a dog-eared copy of The Big Book of Quotes, which I keep in the bathroom and which, I like to think, adds a bit of tone (to both the column and the bathroom). And as usual the Bard was right; ambition may be a flaw, especially when combined with arrogance and incompetence. The desire to be president of the US could be the very quality that makes you unfit to hold the office.

Which leads me to the new plans for the NHS. The prospect of commissioning groups of GPs was bad enough, but now they've added consultants and nurses to the mix, it has become a fatal conclave. All we need is some eye of newt, gonad of frog and so on, and we will have a real witches' brew of inertia and impotence. The consultants will be bad enough; every specialist thinks their own specialty is the most important one, vested interests will masquerade as moral principles on a massive scale, and behind the weasel words of 'patient choice', every dog will be fighting for its day.

But the nurses will be an even more insurmountable problem, because we all know the kind of nurse we are going to see on these commissioning groups. It won't be the kind we meet every day, the kind we admire and respect, the kind whose opinion really means something because, like us, they are out there at the coalface, the kind who put patients first and are ready to roll up their sleeves and get stuck in, however difficult and unpleasant the task.

Instead we'll see the appearance in commissioning groups of the breed who were ambitious, those with the appendages, nursing officers and nurse managers, who weren't happy just being mere nurses, who felt that hands-on care of the old and sick was insufficient for their own needs. Above all else, they wanted promotion, a career trajectory, and their heart's desire was to sit in an office and become experts in shoving bits of paper around.

Fortunately, the GPs who are in the commissioning groups will be level-headed, salt-of-the-earth folk. If you are ambitious, you don't become a GP in the first place.

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