Views & Reviews No Holds Barred

Margaret McCartney: Rigging the NHS for votes

BMJ 2015; 350 doi: (Published 28 April 2015) Cite this as: BMJ 2015;350:h2269
  1. Margaret McCartney, general practitioner, Glasgow
  1. margaret{at}

With just days to go the NHS may be vital to the election, but the politicians’ promises, if only they are elected, are astonishing—in their naivety and their lack of an evidence base.

Labour is pledging a “world class” health system, with a “guarantee” of “a GP appointment within 48 hours, and on the same day to those who need it.” It will offer training for GPs “in spotting early signs” of cancer and says that, by 2020, “patients will wait no longer than one week for vital cancer tests.”1

The Liberal Democrats say that they will “commission a fundamental review of the NHS and social care finances” and will give “patients easier access to GPs and more choice, with more practices open at evenings and weekends and offering phone and Skype appointments.”2 The party also says that, since the “new” general practice contract of 2004, “getting an appointment with a GP outside of the working day is . . . often extremely difficult.”

Meanwhile, the Conservative Party wants to “ensure you can see a GP and receive the hospital care you need, 7 days a week by 2020, with a guarantee that everyone over 75 will get a same day appointment if they need one.” If people who are obese or who have a drug or alcohol addiction “refuse a recommended treatment,” the party says, “we will review whether their benefits should be reduced.”3

The NHS is a community endeavour that runs on “fair use.” It has limited staff, and pledging more access in one place must mean reducing it somewhere else. Pushing for 48 hour access can disrupt continuity of care; this is valued by patients and doctors,4 protects against non-evidence based medicine,5 and relieves concerns about safety.6

It may not be popular, but the truth is that not everyone needs to see a doctor within 48 hours. Some things can safely wait a week. And GPs already have to see patients who are in urgent need on the same day.

There are huge uncertainties about using Skype. And it’s ageist to assume that 75 year olds have more right to see a GP than disabled, multimorbid 40 year olds do. Talking about fair use may not make for easy votes, but it does make for a sustainable NHS.

The worst of the manifesto propositions, however, is the Conservatives’ plan to cut already meagre benefits for sick people who “refuse” treatment. So much for “no decision about me, without me”—and how stigmatising it is to point the finger of blame at these highly vulnerable groups.

We cannot have more reorganisations at whim; everything the NHS does should be underpinned by evidence. The NHS is too precious to be rigged for votes.


Cite this as: BMJ 2015;350:h2269


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