Letters Too late to stop the bill?

We need a shift from reactive to proactive care

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e1225 (Published 21 February 2012) Cite this as: BMJ 2012;344:e1225
  1. John Matthews, general practitioner chair1
  1. 1CareFirst Clinical Commissioning Group, Wallsend NE28 7LP, UK
  1. john.matthews{at}nhs.net

Pity the blind men who find an elephant and each is convinced that he has the correct interpretation of this new object. If the elephant is incomprehensible to a blind man what hope is there for GPs seeking to understand the NHS reforms?1

Most GPs want to provide a good service for their patients. The part of the elephant that is in front of them is their accessibility to patients, the primary-secondary care interface, and the manpower and financial resources of the NHS—a large part of the elephant. Commissioning is not just about service redesign but also about improving service delivery. The quality of primary care is crucial to service efficiency. The proposed reforms provide levers to engage with these challenges in a way that previous incarnations of commissioning did not.

We must be open minded about these reforms because, despite the opposition, no credible alternatives have been proposed. Current Royal College of General Practitioners and BMA proposals for commissioning groups of more than one million patients will not foster local responsibility for quality of service or effective local health and social partnerships. The BMA’s opportunistic call for clinical commissioning groups to have a choice of commissioning support places current primary care trust staff in jeopardy.

McKee’s argument that change is not needed because the system performs well by international standards does not acknowledge that we need a fundamental cultural shift from reactive to proactive care to provide sustainable healthcare in the 21st century.2 The privatisation debate is ideological and should instead be about achieving the best outcomes, as a recent BMJ paper comparing a commercial weight loss service with a GP based service did.3


Cite this as: BMJ 2012;344:e1225


  • Competing interests: GP chair of clinical commissioning group.


View Abstract

Sign in

Log in through your institution

Free trial

Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
Sign up for a free trial