Viewpoint: Dr Kailash Chand: Let's unite to save the NHS and general practice

The NHS is the world's largest publicly funded health service and has helped save millions of lives, writes BMA deputy chairman Dr Kailash Chand in a personal capacity.

Dr Chand: 'The culture of the NHS has been damaged by spurious targets.' Pic: Michele Jones
Dr Chand: 'The culture of the NHS has been damaged by spurious targets.' Pic: Michele Jones

Yesterday,the NHS  celebrated its 67th anniversary, but, now faces one of the most difficult periods in its history. Government policy and privatisation mean the NHS as we know it will be gone in as little as five years. The way this NHS is being managed by Jeremy Hunt and the government is a stunning example of how not to do things. The roadmap of its policies is leading to the complete privatisation of the NHS, a process that has deep roots in Thatcherite ideology. Aneurin Bevan once said: ‘No society can legitimately call itself civilised if a sick person is denied medical aid because of a lack of means.’

The whole service can be taken over by private companies

The new NHS Act has not just repealed society's contract with the health service, but it has made the NHS a repository of privateers with the mindset of venture capitalists. I believe it will be a completely different healthcare system in five years’ time – one which will be much worse in terms of access, equity, health outcomes and cost. The 2012 NHS Act was a dismantling, not a reorganisation. We are inexorably moving toward a system ruled by bogus choice, competition, market forces and diversity of suppliers. By opening every NHS corner to any qualified provider, the whole service can be taken over by private companies, with a few token charities and mutuals. NHS hospitals, faced with the consequences of cherry-picking by private consortia, risk bankruptcy when left to deal only with complex cases.

A recent survey by Londonwide LMCs reveals up to 140 of the capital’s 1,400 GP surgeries could close over the next three years due to staff shortage and financial difficulties. Dr Michelle Drage, chief executive of Londonwide LMCs, warns: ‘This is a three-year time bomb. In the next three years London could lose as many as 10% of its GP practices.’ There are now 7,962 GP practices in England – one in 20 has disappeared since 2010. The rate of loss of local surgeries has speeded up – 79 closed and 55 opened in 2010 but in 2013, 126 closed and only 13 opened.

By the time of next election in five years, the general practice model of the last 67 years will see revolutionary changes, we might begin to see GPs working as part of a broader non-acute sector, in larger teams, in different settings, and for new employers. A new tier of physician associates is planned, along with more nurses and pharmacists. These skilled non-medical professionals could be allowed to take on bulk of work traditionally only associated with GPs. All of this would be unrecognisable to our GP from 1948. Private sector providers want to de-professionalise and down-skill the practice of medicine in this country, so as to make staff more interchangeable, easier to fire, more biddable, and above all, cheaper.

On its 67th birthday we need to pledge to unite as a profession, irrespective of branch or speciality, to save the NHS in general and general practice in particular. The NHS's greatest strength has been the NHS family - the employees who have shown resilience at difficult times, who have innovated to find new cures and treatments, who have provided quality care as their professional code has demanded. They should be allowed to get on with the good and the great things they are capable of doing, and politicians must allow them to do this by giving them appropriate resources and by not playing politics with the NHS. The culture of the NHS has been damaged by spurious targets, marketisation which is causing fragmentation, and competition which is drawing well needed resources away from front line services.

It is not too late to limit the damaging effects of the last three years of the new NHS Act; but politicians need to listen, and staff need to be empowered to carry on doing what they do best - provide excellence in care across the health service.

‘The NHS will last as long as there are folk left with the faith to fight for it.’ (Aneurin Bevan, 1948).

  • Dr Chand is BMA deputy chairman and is writing in a personal capacity

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