Law of supply and demand applies in NHS

Editor—So recognisable was Jeffrey's description of his wife's doctor's surgery that I read his end piece with discomfort, as I had a strong suspicion that his wife was a patient of mine.¹

I was pleased to discover that it was not our service being described, but I was also interested because I had made the same comparisons between my surgery and the local veterinary surgery when my own cat had been unwell. I had found consolation in the argument that, as a public service, the NHS does not have the same laws of supply and demand that the private sector vets have. If a vet's workload rises, I thought, then so does their income. With that they can employ more vets without the approval of the veterinary equivalent of the Medical Practices Committee, and thus maintain a similar level of service no matter what the demand.

My consolation was stolen from me, ironically on the day before I read the end piece, by a friend not employed in health care at all. He pointed out that the law of supply and demand has to work in the NHS, because it is a universal law that has to work everywhere, but I was looking at it from the wrong point of view. I had said the law doesn't work, because I cannot increase the supply just because the demand increases. But in the world of business, if the demand increases and the supply does not, the price rises. This integral part of the supply and demand law is already working in the NHS. Granted, people are not paying money to see me (yet), but the cost, in terms of time spent in the waiting room, quality of public address system, length of consultation, time spent waiting for an appointment, hospital waiting lists etc, has been rising for as long as I can remember.

In the months and years to come, particularly if a majority of general practitioners decide to resign their NHS contracts next April, the public, politicians, and the profession will have to negotiate how this price is to be paid. It will be many years before we are in the position that our veterinary colleagues are in and simply take on new staff. Given that, the price must continue to rise for as long as the demand does. Would Jeffrey be happier with the status quo, or would he prefer that his wife see my receptionist for the bill on the way out?