Letters The unravelling NHS

Instead of jumping up and down we must propose alternatives

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2442 (Published 02 April 2012) Cite this as: BMJ 2012;344:e2442
  1. Michael Schachter, senior lecturer in clinical pharmacology1
  1. 1Imperial College London, St Mary’s Hospital, London W2 1NY, UK
  1. m.schachter{at}ic.ac.uk

Undoubtedly, the Health and Social Care Bill is a very bad bill,1 but we must reflect on where we are at the moment. The current system of primary care trusts and acute trusts has already grossly fragmented the NHS. Many doctors spend endless hours generating policies and formularies that are just slightly different from those of the trust next door.

We are familiar with the farce of “commissioning.” We see impediments to internal referrals purely because of funding streams. Most issues of Private Eye contain cases of iniquitous treatment of doctors by trusts, which lead to months or years of “investigations.” The victims are usually vindicated and the taxpayer foots the bill. Trusts have acquiesced blindly to the European Working Time Directive, at great cost and clear damage to the continuity of patient care and the quality of clinical training. We are approaching revalidation, a system with no evident validity. It is meant to “reassure the public,” but no lay person to whom I mentioned it had a clue what it was about. They can see that the tragedy of Shipman would not have been prevented by this process; indeed, he would probably have been one of the “responsible officers.”

Our profession is jumping up and down having found most of the stables empty but is not proposing alternatives. Just saying we need “more resources” does not do the job.


Cite this as: BMJ 2012;344:e2442


  • Competing interests: None declared.


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