The news that patients should be allowed to register with any GP practice is apparently supported by all the political parties. It suits the modern conception of people as solipsistic consumers, increasingly motivated by convenience and satisfaction.
Lawrence Buckman interviewed on Today this morning said most of what needed to be said. The Government’s enthusiasm for adding bureaucracy to the NHS might make it possible.
What Dr Buckman didn’t say was that a great strength of GPs presently is their level of local knowledge frequently built up over many years. In the 6 partners in my practice we share 79 years of experience working in South West Hackney. We have an in-depth knowledge of the NHS and voluntary sector services, which work well and which don’t, who to call where and when, who’s worth referring to, and who ought to be avoided. We know the streets and the estates where our patients live and work. We know the relationships between generations of local families.
We know that most of our patients’ experience of life, illness and suffering are bound up in their relationships with other people and with their environment. We know how to work as part of a large and complex team of primary care, social services, voluntary sector and hospital specialists. We are local experts for our local patients. If we are to look after anyone from anywhere we can’t be that kind of expert for everyone.
A Better NHS 
I can see what you mean. In Cambridge, we have an out-of-hours GP system called Camdoc based in Chesterton Hospital which works very well, but a certain amount of time is spent reinventing the wheel as regards patient history.
On the other hand, my boss comes from a long way away but can’t register with a GP in Cambridge, which means if she needs to see one she has to take most of the day off.
So there’s pros and cons. This is a surprising development to come from Gordon Brown, who usually doesn’t think much of choice – see his record on plebiscites. But I should note that the idea was originally put forward by the Conservative party.
Its definitely a problem for people who are working away from home. The more time GPs spend monitoring and screening the well instead of caring for the sick, the harder it gets for people to justify taking time off work. In some halcyon past people went to see their doctor when they were sick and could justify missing work. These days we badger them incessantly to attend lifestyle modification therapy sessions which employers unsurprisingly are less keen to support.
Our surgery has started opening from 8am to 8pm and from next month, on Saturday mornings as well which I’m sure many more will start soon. That will help and avoid too much damage to continuity.
Does that mean that you’ll have to work longer hours?
Andy Burnham’s new advisor is Kieran Brett. Kieran Brett was Tony Blair’s chief political adviser on home affairs. According to an article he wrote for Prospect magazine he’s keen to involve the private sector in the NHS.
It’s not a situation of Saints and Sinners. GP Practices are also businesses which partly rely on numbers registered ,bringing with them all sorts of incentives and bonuses. Those who believe they can provide best in the private are not the monsters of Capitalism some make them out to be! The UK needs a mix of provision rather than the two tier system which has beefited mainly the rich so far. It will be interesting to see how nepotism and the networking described by some practitioners (see comment above who oppose the changes will fare. Is it really ethical to run services partly using nepotism and networking which inevitably benefit some and disadvantage others? Do some practitioners need to look rather more deeply into notions of giving up degrees of influence and control?
If you look at the other posts you’ll find plenty of carefully argued, referenced points about the risks of private health care. If you’re concerned about doctors who have a long term committment to and intimate knowledge of their patients giving up control and influence to corporations who care nothing for and understand nothing of the lives or suffering of patients then we should share an ale together some time.