Samir Dawlatly: Could general practice survive without the NHS?

General practice is often described as the cornerstone of the NHS. Though its funding doesn’t necessarily reflect this, having its proportion of funding decline in recent years, 90% of all interactions with patients happen in general practice. It is therefore easy to predict that if, for whatever reason, general practice were to collapse or cease to exist as we know it, that the NHS itself would be threatened. The only alternative place for patients to go would be hospitals, via accident and emergency. That is probably an apocalyptic view given that one would hope that if general practice, as we know it, was to cease to exist that this would not happen overnight.

As a GP I have to hope that general practice, in some form, will continue to exist for some time and so the more intriguing question is whether it could survive without the National Health Service. This fascinates me for a number of reasons. Firstly, I am of the strong belief that at some point in the next few years the NHS will cease to exist, in the sense that it will not be funded entirely through taxation, but through mandatory health insurance or co-payments. I also believe that nothing can be done to prevent this from happening because there is an elite group of policy makers and shapers from all aspects of the political spectrum that are set on it. Furthermore, due to advances in health technology and the ageing population the NHS simply cannot be all things to all people for free on a low budget.

If I am wrong, as I often am, then the survival of the NHS will require some honest questioning about its function and its funding. It has been said before that it is impossible for the NHS to be quick (have short waiting times), high quality, and cheap. Two out of these three are possible at any one time. Politicians and the public have to decide where their priorities lie. The survival of the NHS would, I imagine, mean that general practice would continue to play the role of gatekeeper, hopefully with more GPs and better morale.

The problem is that talking about the possible demise of the NHS causes a great deal of emotive defence of it. It is the main health system that has been known in this country for over 65 years. Many of us have not experienced the positives and negatives of other types of non-socialised health systems. The pro-NHS cheerleaders constantly point to health inequalities in America as an example of what happens to a society with privatised health. However there are other countries with better health outcomes in terms of life expectancy that run hybrid systems with private and public funding of health, such as Japan, Andorra, Australia and Italy, or have a compulsory health insurance system, as it is in Switzerland. These countries have the best longevity figures according to the World Health Organisation.

So perhaps a socialised health system is not the best in terms of outcomes, but it remains an ideal that many within the NHS are wedded to? This means that many organisations within it devote much of their resources on saving the NHS, protecting the public from its demise. As a result it seems that only the private health companies are planning ahead to see how healthcare in the UK might work, if and perhaps when the NHS is completely eroded by neoliberal politics.

In a world without the NHS, people will still be sick and need health professionals. In the future healthcare professionals just might be paid by a combination of government, individual, and health insurance contributions, and appreciated more as healthcare won’t be viewed as free and available to be taken advantage of.

It makes more sense to me to plan for the inevitable than devote all your energy pushing back against it.

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.