Belfast Telegraph

A dose of reality would do the health service no harm

By Matthew Norman

We have only one national religion, Nigel Lawson famously observed, and it is the health service. The former chancellor was bang on the money back in the 1980s and today most of us still worship the great monolith.

For all that, one sniffs a rise in heretical questioning — even agnosticism. No sooner have the angels of geriatric nursing been stripped of their wings than the local priests — our GPs — come under attack.

Complaints about GPs summarily removing patients from their lists rose across the UK last year. A number of family doctors now appear to operate a zero-tolerance policy better suited to one of those publicity-crazed sheriffs beloved of rural Alabama voters.

The rules which dictate that GPs observe a careful process before sacking a patient are being ignored, we are told.

As always with the health service, it is hard to gauge the scale of a problem from the statistics alone. But, invariably, we judge the health service’s own state of health not from waiting-list times, or cancer-survival rates, but from personal experience and anecdotal evidence.

Every trade has its fools and nutters and you cannot judge a profession by the pathological idiocy of the odd individual. And yet there is that osmotic sense that too many GPs have forgotten — if they ever knew it — that theirs is a service industry.

I trust no physician will take umbrage if I describe the typical GP as a glorified plumber with shorter hours, much better pay and a less-cumbersome toolbox.

No offence is intended, because, to me, the simplest precepts of plumbing are as awe-inspiring as those of car mechanics, or deckchair assemblage. The challenges facing the GP are, in fact, less opaque.

The hypochondriacs among us tend to regard themselves as doctors who never bothered with the petit bourgeois requirement of formal training. And I am a consultant diagnostician of the first water.

Writing as such, I have enormous sympathy for the humble GP. He, or she, is obliged to spend most of a draining 45-hour week dealing with athlete's foot, housemaid's knee and minor infections of the upper respiratory tract. Also writing as such, I have even more sympathy for any GP who has to deal with the likes of me.

I wouldn't wish myself — armed to the teeth with internet-published research papers and results of double-blind clinical trials — on Dr Shipman, Dr Mengele, or even Dr Fox (and his faithful sidekick Nurse Werritty).

Yet that sympathy is tempered by the suspicion that the improvement in GPs' pay and conditions over the last decade-and-a-half is alienating them — or more of them; one hears as often of brilliant and empathetic GPs as of cocky, clueless ones — from those who effectively pay their salaries.

A century ago, in his coruscating foreword to The Doctor's Dilemma, George Bernard Shaw regretted the typical physician's poverty. Today, our GPs are much the most lavishly rewarded in the Western world, with £100,000-a-year not even the average.

Many make twice that and some thrice, in spite of no longer being obliged to work outside office hours, so that the nocturnally stricken are left to the untender mercies of often inadequate locums. In return for such reimbursement, we ask no more than a fairly prompt appointment with a competent doctor and that the receptionist not be styled after the waiter who is trained to insult punters to ensure the table is freed up as quickly as possible.

Much too often, anecdote insists, even these modest expectations are unmet.

Over-indulgent treatment by Government has a knack of divorcing public servants (even if most GPs are technically self-employed) from the public they allegedly serve.

The reputations of every once-cherished institution have bombed in recent decades and, like the BBC, the health service has been latterly weakened by the perceptions of bloated budgets and insular arrogance.

I wouldn't describe the health service as the opiate of the masses (you try asking your GP for liquid diamorphine), but it is a religion. And, in common with all religions, it relies on the sustenance of faith.

Peremptorily excommunicating the dying is a shocking betrayal of that faith and should be no more tolerated than priestly interference with choirboys.

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