THE BRITISH HEALTH SERVICE

1. Read the interview of Hillary Max-Hyslop with a British General Practitioner (GP). What new facts about the British National Health Service have you learned?

The British National Health Service (NHS) was set up in 1948 with the intention of providing free health care for every­one. Recently it has been going through a period of reorganizati­on. Those in favour of the reforms say that it is vital for the NHS to adapt to society today; advances in medicine have meant that people are living longer than ever before and the NHS must make the very best use of its resources. Those aga­inst the changes say the reforms have led to a worsening of the services provided. 'Kaleidoscope' has devoted the whole of this issue to an interview with a doctor, working in Cambridge. The doctor is General Practitioner (GP) who works in a practice.

Interview: the National Health Service

— Can you just explain "General Practice" and the role of a GP?

— Well, general practitioners are the first port of call for any patient, so they provide the primary healthcare. Something like 80 percent of medical interactions are with GPs, and only a very small percentage go on to hospital.

We are contracted to provide medical services for all our patients 24 hours a day.

— You say 24 hours a day. Do you work days and nights?

— I work part-time, so I work half as much as my full-time colleagues. I work from lunchtime on Monday to about 7.30 in the evening, including an evening surgery. And then I do a half share of nights and weekends.

— Could the NHS restrict night work and home visits?

— I think it must be feasible in that we are the only country in the world that provides this service. A lot of other countries manage by patients travelling to primary healthcare centres. One of the things that's happened over the last few years is that the Government has brought out their Patients' Charter, which lists the rights of patients; since then, there has been a rise in the number of out-of-hours-visits requested. There's a big move to change the system. Patients who can travel come to a healthcare centre and see a doctor who is waiting there to see people. It seems to be working quite well.

— Do you feel you have enough time to see patients?

— Just. We have an appointments system and we see pati­ents every ten minutes. And if you have a patient coming back who you know has got a complicated problem, you can always get them to make a double appointment.

GP's are self-employed and have a contract with the local Health Authority, so practices can decide on their own appo­intments system. Nobody dictates how you should arrange things, except that now, of course, it's easy for patients to change doctors.

— Since the recent reorganization, the National Health Service (NHS) is frequently in the news. Do you think it's still worthy of admiration?

— Yes. I think it's certainly true that even before the recent reorganization it was one of the cheapest health services in the Western World, and yet provided as good care as any. So I think it always has been efficient.

— There have been considerable changes. Can you explain the main ones?

— Well, in the hospital service, individual hospitals have been invited to become self-running Trusts, so they organize their own finances and the services they offer. So there is an element of competition coming in between the different hospi­tals. The idea of the old National Health Service was to provide everybody with the same service.

And the other change is that GPs have been encouraged to become fundholders, which means that they get a budget at the beginning of the year and every time they refer a patient to a hospital, they pay for that particular referral.

— The Government is always telling us that there's more money for patients. Do you agree?

— I don't know. Waiting lists seem longer than five years ago, but I don't know whether that's due to increased demand or limited supply.

— One criticism of the NHS now is that there are too few doctors and nurses and too many managers. Do you think that criticism is justified?

— I don't — think that there are fewer doctors and nurses than before, but I think that the demands being made on them are greater. We have an ever-enlarging, ageing population, with more medical treatments available, so that doctors are stretched more than they were. We certainly have more managers. The whole structure of the new fund-holding Trust system requires lots more managers.

— Do you think that if resources are more limited, the NHS should give the public more details about how doctors make Judgements as to who goes to the top of the queue for treat­ment, and why a particular course of treatment is chosen?

— Who a doctor treats and how is a clinical decision and I don't think you gain anything by that being opened up. Mr. X is not helped by knowing that Mr Y is worse off than he is. But I think the decision about how much treatment is available is political.

— Do you think it is unrealistic to expect that one can have a free health service?

— No. I would be very upset if it was ever any difference from that. Most of the doctors I know would agree that medical care should be free at the point of the delivery. But there are health authorities now where certain areas of treatment, for instance varicose veins surgery or plastic surgery, are no longer available free on the NHS.

— Do you think medicine is going to change dramatically in the next twenty years?

— I think that what is changing faster than the medical advances are the political aspects of the delivery of the service. It will depend on what happens at the next general election.

The GP was interviewed by Hillary Max-Hyslop, Kaleidoscope

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