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Br J Gen Pract. 2007 February 1; 57(535): 167.
PMCID: PMC2034193

Into the Black

I'd already written 2007's first column when the good news came through. Not only will the NHS come within budget in 2007, but it will actually go into surplus. So the good news is that we won't have to put up with Patsy Hewitt much longer. Having promised to resign if the NHS doesn't balance its books, she's as good as gone.

This isn't really the good news it pretends to be, because no one else will be any better, although they may be less patronising. However, as the NHS has never been within budget, it's difficult to see how it will happen this year, other than by some sort of distorted accounting (which the government is far too principled to countenance), or by the wholesale dumping of staff and services (ah yes!). Richard Lehman, in his reviews of the journals, commented on Rudolf Klein's peculiar editorial in the Christmas BMJ. Klein likened the NHS to a bobsleigh, any attempt to alter course leading only to disaster. But the government is largely responsible for the course. Its past pronouncements have dictated its twists and turns, and the conditions of the ice. There are many ways the government could make the course less hazardous, but it just doesn't want to.

We can apparently save loads of dosh by sending patients to their GPs for postoperative checkups. The idea (apart from swamping GPs who already have enough to do) is to allow surgeons to do what they really want to do, which is more operating. How this squares with audit and reflective practice I'm not sure. If surgeons don't see their patients postoperatively, then how will they judge the success of their surgery? Contrary to the ideas of the bright sparks who came up with this, surgeons quite like to see normal patients doing normal things; it's disheartening and distorting to see patients only when something has gone wrong. Mind you, as we're already losing our SHOs from preoperative assessment clinics, we're well on the way to what the government wants: lots of cheap technicians churning out operations on a production line, satisfying shorter and shorter government targets for times to treatment. Surgeons won't be titled Mister because of harking back to the barber-surgeons; they'll be Mister because they are no longer doctors.

But I remain puzzled. Why should the NHS go into surplus? It's a public good, not a widget factory. Maybe the idea is to use the NHS to fund body armour for our lads and lassies in Afghanistan and Iraq.


Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners