Not with the state apparatus

doi:10.1136/bmj.39296.740116.3A

BMJ 2007;335:272 (11 August), doi:10.1136/bmj.39296.740116.3A

Letters

NHS-saving general practice

Not with the state apparatus

The first 150 words of the full text of this article appear below.

Heath believes that it is governments which are sapping themorale of general practitioners (GPs), by introducing the twinevil of markets and private profit.¹ She forgets that it wasthe GPs themselves who agreed a new contract that abolishedtheir commitment to 24 hour "social solidarity," while givingthem better rewards.

The special role of primary care doctors in the United Kingdomis already sullied. The possibility of their recovery to a central"gatekeeping" role is offered by primary care commissioning.But the information technology and management add-ons make thispeculiarly unattractive. Could it be the health service managerswho are determinedly undermining the GPs' morale and esteem?The one continuous thread throughout the past 50 years of theNHS has been the desire of the state apparatus to "break thepower" of doctors, and bring them to heel—while securingtheir own continued expansion of power and inefficiency.