Machiavellian hand behind polyclinic plan

How does anyone reform a government department which is perceived to be inefficient without falling foul of the Sir Humphreys?

The Machiavellian answer is quietly to create a new, parallel department, then without warning close down the old one as being surplus to requirements.

The GPC has suggested that the government is planning something extremely hostile to GPs, but isn't sure what form it will take. Here's what I think the government will do.

First, convince the general public that GPs are lazy, greedy, selfish, and not really interested in their patients. Next, create a network of super-surgeries and insist that they open 12 hours a day, seven days a week. Nearby practices won't be able to compete because they won't have the manpower. Proclaim the experiment a national success and plant increasing numbers of APMS surgeries throughout the land.

Now withdraw the MPIG and forcibly renegotiate all existing PMS contracts. At a stroke the majority of surgeries will be financially destabilised and many will close. The partners, not the state, will have to bear the cost of redundancy payments; plus, with no incoming partners they won't be able to recoup their capital investment in their premises. However, patients won't be inconvenienced because there will be a super-surgery just around the corner.

As a result, a large percentage of the population will be shifted into the new super-surgeries, run by a handful of private providers - much easier for the DoH to control. The private providers will also be performing much of the quality control work previously carried out by primary care organisations (PCOs): saving the DoH the cost of PCO staff. All sub-standard GP premises will be eliminated, and because the Darzi surgeries use cheap salaried doctors the overall running costs of primary care to the state will fall by up to 25 per cent.

Then trumpet the achievement of putting primary care into spanking new premises whilst getting rid of the existing 'incompetent, unavailable, overpaid' GPs.

Now most GPs are in new premises, working all hours, under nearly direct government control and at vastly reduced cost to the Treasury. QED.

Dr Lancelot is a GP from Lancashire. Email him at

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