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01-04-2012 | Article

United we stand, divided we fall?

The phrase "National Health Service" implies a countrywide organisation. But as time has moved on, the word "National" has become a little compromised. In the four countries that constitute the United Kingdom, the NHS seems to be pulling in different directions and performing different functions and roles in how it delivers healthcare.

Of course it is good in some ways that we don't have a centralised, cumbersome organisation directing healthcare. The NHS is the world's fifth-largest employer, with an eye-popping 1.7 million employees (click here to read more about the world's largest employers), and it is difficult for such a mammoth employer to be locally responsive. So does it make sense to create regional versions of the service that deliver healthcare in the most locally appropriate manner?

I have considered this issue for some time and I feel there are no easy answers. A large organisation can have economies of scale but there is a risk of inefficiency - one size does not fit all. There are also political considerations to bear in mind; some areas of the UK may be interested in independence or more freedom from the centre and want to run healthcare their way.

According to an article recently published in the Univadis GP news service (click here), the Royal College of General Practitioners has "called for a UK-wide approach to healthcare based on core unifying principles across national borders". Of course, they have "urged health ministers to put general practice at the heart of this approach".

My preference would be to keep the "National" in the NHS while also attempting to respond to each of the UK regions and following the RCGP's proposal of a UK-wide approach to healthcare. Should GPs be at the centre of this? Of course I am biased, but I recall a fascinating fact sheet issued by the RCGP a few years back (click here). It stated that "around 90% of all the health needs of the British population are managed in primary care by GPs, working with practice and district nurses and health visitors."

Of course we will always need secondary care and the myriad of other services that the NHS provides, but it makes sense for GPs to be at the centre of this activity. Another persuasive argument comes from the same RCGP fact sheet, which states: "General practice/primary care is the most cost-effective part of the NHS - GP care for a whole year costs less than a single day's hospital admission."

The RCGP has now moved on from the controversy over the government's proposals to reform the NHS. In my mind, general practice still has a lot to offer the NHS; to the politicians, we also offer cost-effective health care. That alone should ensure our place at the centre of the ongoing development of the NHS. I just hope it remains a truly national service that delivers effective healthcare, free at the point of delivery, to the whole nation.


Dr Harry Brown, editor-in-chief Univadis

By Dr Harry Brown