Oh Schizophrenia*

Before I start, I must make clear that I have nothing against GPs. For the most part they are dedicated professionals who provide a much valued service and have their patients interests at heart. (I have to say this as there is at least one GP who drops by hear now and then.)

No doubt you can that there is a big *BUT* coming up and here it is -- they do have schizophrenic tendencies. Many people assume that they are just part of the NHS, but this isn't so. Quick history lesson, when the NHS was created 60 years ago next week, GPs and their union, the BMA, wouldn't play ball and Nye Bevan had to compromise and let them stay independent contractors paid by the NHS to provide family health services.

What this means as we approach the diamond jubilee of our jewel in the crown is that the vast majority of GP practices are small businesses and this is where the schizophrenia kicks in -- the BMA will opt to be independent contractors or part of the NHS family depending on the circumstances.

And sometimes both at the same time. Take this example from Redcar and Cleveland. GPs there have joined in the disengenuous Save Our Surgeries campaign by issuing their own leaflets with the NHS logo at the top. BMA policy at odds with that of the NHS.

It may seem petty that the local health bosses stopped them doing it until they snipped off the logo, but imagine if you got a branded letter from your building society saying you could have a mortgage and another saying you couldn't. You'd be confused.

That is what the NHS risks becoming -- a family at war with itself as the Masterson Inheritance would have it. For an amusing and oddly accurate description of BMA and GP schizophrenia, see the HSJ's Your Humble Servant column this week:

I still get confused about how you can claim to privatise a privatised service. GP surgeries are built with taxpayers' money - which passes straight into the hands of private entrepreneurs. It is the most glorious pension scheme you could ever get your hands on. And what the numskulls still haven't worked out is that if you take more work out of hospitals and give it to primary care, then that's even more geld they'll be able to trouser.

* Oh schizophrenia, I know you, I been yer, So subtle....la la la ( Cockney Rebel - Muriel The Actor)

NHS SOS?

Whenever a hospital service is earmarked for change or closure, local people automatically blame politicians or NHS managers. The reality is that such changes are driven by the medical profession which in the past has been loth to admit that small hospitals generally equal crap and often unsafe services.

Thank goodness they are finally putting their heads above the parapet:

"The public does seem to agree with the broad principle of larger centres and better facilities, but what people also want is an all-singing, all-dancing university teaching hospital at the bottom of the road."

So says James Johnson, head of the British Medical Association, and of course you can't have both and only the former is practicable. Read more in the Observer.