“So what difference would it make if the NHS was privatised?” asked a medical student this week. We had just been discussing my pet conspiracy theory: that the bad press GPs and other parts of the NHS receive is actually an orchestrated attempt to destabilise the faith of the population in it. The modus operandi for privatising any public service seems to be to restrict the budget, drive up demand, and use the media to tell everyone how appalling the service is. The end result is to create a climate where privatisation would seem like a good thing.

I hadn’t expected such an incisive question from the students, forgetting that they were, of course, among the educational elite of their generation. So I paused.

“Good question. To be honest, no one really knows because it is a hypothetical question. You can look at other places in the world, where the healthcare is not provided for free by the government, and try to surmise whether we would end up like them,” was the gist of the first part of my answer.

I’ve spent over half of my life either in medical education or working as a doctor, and the provision of the NHS, free at the point of need, has always been something that has been defended resolutely. Defenders of the faith in the NHS will always cite the healthcare system in the United States as an example of when private healthcare goes wrong, by being inefficient and unjust in the way that it doesn’t ensure the neediest have their needs met. I’ve heard the argument that if the NHS was privatised, we would end up like America, with this being the strongest argument against it.

If the NHS was privatised, if the NHS, if, if, if . . . If?

My belief in my conspiracy theory, which is also held by others, leads me to think that we should no longer be talking and debating about “if the NHS is privatised,” rather we should be discussing what to do when the NHS is privatised. Despite the relatively unreported private member’s bill by Clive Efford to repeal sections of the Health and Social Care Act 2012, protestations in the medical press, and murmurings of another bill in the next parliament to undo the Health and Social Care Act, I just can’t be convinced that the public or the doctors that serve them will be able to do anything to stop the relentless march to privatisation.

We may feel that we can win small battles by creating a fuss in social media about yet another backstabbing from the government or health quangos. We may fight back against the increased demand for patient access to our time, our notes, and our lives. We may resist the changes to the terms of service that are imposed, with loud voices and gnashing of teeth. But there is only one way that it is all going to end: privatisation.

The government and the healthcare organisations waiting in the wings, can simply set up their caravan of unfriendly media and so called regulations outside our citadel of healthcare and starve us to death, all the while feeding an agenda to our patients until they get to the point when they will be glad to be rid of the NHS.

And then what will happen? What difference would it make to healthcare in this country?

And therein lies the £110 billion question. Partly it depends on whether our economy, including our health economy, is opened up to the Transatlantic Trade and Investment Partnership. One would think that that could tip us towards an American model. But there are other models of healthcare around the world. We have been faithful to the state religion of the National Health Service for so long that we don’t really know how other countries get by. We only know that we don’t want to be like America.

My feeling is that if privatisation is inevitable, or even if there is a very strong chance of it happening, then we should be planning for that eventuality. The private healthcare providers will be making their plans to try to get their share of £110 billion, so we too should also be planning how to ensure that patients’ needs remain at the centre of healthcare provision. I wonder if I should spend less energy trying to win small battles when the outcome of the war is already decided, but rather retreat and plan ahead for the post-privatisation era.

I certainly don’t trust politicians, private health providers, or the media to work that out. The only people who can do it are those who work in the NHS today. Although it may gall to admit defeat, we nonetheless need to start having those difficult conversations and start planning now.

Samir Dawlatly is a GP partner at Jiggins Lane Surgery in Birmingham. He combines clinical practice with being a part time house husband and an interest in social media, as well as publishing poems, essays, and blogs. He can be found on Twitter as @sdawlatly.

I have read and understood BMJ policy on declaration of interests and declare the following interests: I am a member of the RCGP online working group on overdiagnosis.