Flexibility

One of the things that has been the hallmark of General Practice in the UK over the last 30 odd years is our ability to adapt to change.

It was, of course, too much to hope that Government would avoid huge managerial changes and strategic plans; this one has been no different with its boast of the 'biggest change in the NHS in the last 40 years'. That is, of course, the biggest change since the last one which was, well about 2 years ago.

As the ministers and commentators observe the effects of their "bold vision" and "strategic planning", I am happy to tell them how much difference this will make to most Jobbing Doctors - very little. You see we have seen this all before.

What does not change is what I do every day, and what I have done for the last third of a century. Sitting with a patient, listening to their symptoms, examining them, arranging tests, coming to a diagnosis, instituting treatment and generally seeing them get better. No amount of high-noise managerial change makes a fig of difference when I am in my consulting room.

My pay might go up, or down. The diseases may change a little, the treatment and tests will change and improve. But life goes on.

GP consortiums commissioning care? A big idea? Doubt it.

Sacking loads of middle managers? Think of the redundancy packages.

The likely thing is that we will undergo a period  of managerial inertia and lack of decision making because if PCTs are to disappear, then what will happen to the functions they perform?

I cannot see this new idea making much difference. It may well get stuck in the sand. In addition, it follows the usual format of having an absurd title for a White paper. The title is Excellence and equity: liberating the NHS. Absolute nonsense, in my view. How about Changes and More Changes: How Governments muck up the NHS? That'd be nearer the truth.

Am I being pessimistic, or realistic?

We shall see.