The introduction of walk in health centres—the end of general practice?

Editor—The prime minister’s announcement that walk in health centres are to be set up beggars belief.¹ One of the crucial strengths of British general practice is the ability to register with a general practitioner. That doctor is able get to know patients and their families, such knowledge contributing enormously to the quality of advice that can be given. It saves a lot of expense in terms of time, unnecessary investigations, and treatment if the doctor knows the patient.

Abandoning such a fundamental component of the system has hit the first nail into the coffin of traditional, cost effective general practice. The promise of instant and late night access panders to the selfishness of consumerism. It is a foolish, expensive way of disregarding a system that would work well if it were adequately funded. Inappropriate demand will be inappropriately met by staff who do not know patients and may never see them again. Such staff will have little responsibility for their ongoing care or the consequences of their actions for patients’ health or local health budgets. Of course many patients will welcome the immediacy of this innovation, the apparently virtuous staff who run the centres, but they will be unaware of the effect it will have on the NHS as a whole or even on themselves.

Inadequacies in the current service should be tackled at their roots and not sidestepped. Late night opening could be a regular feature of general practice if there are incentives. Spending £30m on 20 new centres duplicates the investment the NHS has already made in surgeries across the country. A salaried service is only appropriate where new general practitioners decline to work. Even then they should have a list.

Maybe we were wrong to scoff when Margaret Thatcher famously said, “The NHS is safe in our hands.” Did we ever think things would come to this? It seems that the time is up for independent contractors if we take this lying down.