There are two issues.
Firstly general practice does not match the lifestyles of
politicians, journalists and some other key opinion formers. It may
be extremely good for a large number of people, but its weakness in
caring for both opinion formers and the most needy is a serious one.
Secondly it's not feasible to run an NHS as originally conceived that
will meet the consumerist expectations of a modern society. Further
it may not be feasible to run an NHS as originally conceived within a
European Union with free movement of people, and be the only country
to have such a system.
If the NHS is not sustainable long term (and it probably isn't) then
no government wants to face the responsibility for destroying it. If
they treated nurses badly the government would still carry the
can. They do treat managers badly but no-one cares and anyway until
now there have always been more coming forward to be canon fodder.
Only by seriously upsetting doctors could the government hope for the
collapse of the NHS with its current aim of comprehensive health care
accessible to the whole population.
The BMJ asks whether this is cock up or conspiracy. I don't think
the two are mutually exclusive. Some play the game knowingly, some
are just pawns in the greater scheme of things, often quite capable
of cocking things up all by themselves.
If this is one version of a reasonable analysis, one of the
fundamental questions is just how wrong the government is to do what
it's doing. Is it just a little wrong because it's trying to do the
right thing for the country but in a rather underhand way? Is it
trying to do the wrong thing altogether? Does it have the right to
harm a generation of doctors for its political ends? It does have
the right to send people to their death so the pain suffered by
doctors might well be considered legitimate by some.
Of course most people don't think like this so maybe the questions
are all just rhetorical.
One of our local consultants, no risk factors known, died young last
week, probably of an MI. I wonder if his ghost will haunt NHS
management. I wonder if it does, whether it will be the only one.
Julian
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