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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 June 16; 334(7606): 1276.
PMCID: PMC1892479
From the Frontline


Des Spence, general practitioner, Glasgow

I am going to give this 110%. Sporting analogies are everywhere, for sport is a microcosm of life itself. Sport incorporates important themes like the team over the individual, obeying rules, the threat of sanctions, persistence, endurance, pride, effort, structure, hierarchy, and—all important—the need to meet defeat and victory with equal measure. Perhaps these crude analogies are legitimate and we should view the NHS as just another big team game.

Let's work this sporting analogy further. The NHS is at risk of becoming American football: teams within teams, producing reams of meaningless statistics; constantly changing shifts of players; superspecialised players performing one single task; start-stop, clock watching, pointlessly technological; glitzy, covered in layers of padding, pumped up on growth enhancers with unknown long term consequences—even the gleam of the pitch is utterly synthetic. Just expensive and complicated, but worse still: interminable and dull. Our population of health spectators, now obese, gazes on, chomping on foot-long hotdogs as they guzzle down their gallons of fizzy drinks. The announcement system blasts out a deafening and distorted version of “We are the Champions,” drowning out any dissent. All attempts to export this sport, perhaps not unsurprisingly, have failed.

But the traditional model of the NHS is one of a soccer match in a dog fouled city park. The nurses are the defence: solid, dependable, organised, and quietly getting on. The GPs are the midfield: holding the ball, playing it around and holding the possession, helping in defence but sometimes going forward. The consultants are the two fiery glory hunters up front, aggressively seeking to score that all important diagnosis. This game can be played from the slums of Rio to the icy suburbs of Reykjavík.

So you can stuff staying up half the night for the medical superbowl party; I'd rather wash what's left of my hair. Give me my NHS football world cup, a truly global event with poverty no barrier to success—played the world over and a health meritocracy of global proportion—poor, rich, black, white, a thousand different languages; medical care played out by small national teams full of lithe, multitasking generalists, dependent on each other, therefore respectful of each other's roles; teams committed to primary care based, integrated, inexpensive, and centrally funded medical care—an event where a truly gifted individual can make a big difference and raise the morale of a whole nation. There is the odd shouting match, but these get “sorted” in the pub afterwards. It is the NHS's complete simplicity that makes it so beautiful and highly regarded. Had enough? I've done my best and you can't ask more than that.

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