‘Life carries on without GPs. In fact it’s a lot simpler’

To: Don Wise, chief executive
From: Paul Servant, assistant chief executive
Re: A primary care-bled NHS

Dear Don

I got to thinking this holiday, after the professional executive committee chair had flown to Honolulu for Christmas and New Year. Most of his colleagues packed up as soon as the private schools’ term ended. Does Father Christmas only deliver presents to GPs on ski slopes or sandy beaches?

So, we had no primary care for Christmas - no surprise there - but it struck me there is an opportunity here. How much difference does it make when the GPs are away?

Are there still hospital doctors, paramedics, nurses, pharmacists and even social services around? Yes. No dentists, obviously, but that’s not confined to Christmas.

Life carries on without GPs. In fact it’s a lot simpler. We don’t have to labour under the false expectation that they act as a filter or gatekeeper and are therefore ready to deal with the undiluted public 24 hours a day.

Let’s also remind ourselves that, when they are here, it’s a strictly 9am-5pm service. GPs don’t visit you at home, at night, or in nursing or residential accommodation. Yet they all have company cars.

So let’s abolish them. GPs are costing a fortune to weigh people and give them flu jabs, dole out antibiotics like sweets and refer everything to the acute sector. They even require other GPs to second-guess their referrals.

Vertical integration is the name of the game. We should use paramedic and nurse community triage for direct access to all our services. We would have a direct interest under the tariff not to inappropriately refer or admit and it would be cheaper. Every child could see a specialist nurse or consultant and patients could shop around rather than being stuck without choice in their local surgery.

We wouldn’t even need PCT commissioning. Without GPs, what would be the point of PCTs? We would save a fortune on doctors and PCT salaries which, pound for pound per hour available, have less impact on patient health than any other part of the NHS.