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End Game

Posted by Dr No on 15 February 2012

ozymandias.jpgDr No is getting increasingly bored by the futility of the gesture politics flaming round the NHS reforms. Being bored, he found himself, by quirk of a daydream, thinking of another kind of bored, a chess board, and for a moment he saw the end game of this blasted bill as a game of chess, played not on a square, but on a triangle. Three opposing GP sides – for as Dr No has said many times, it is in the hands of GPs that the fate of the bill now rests - face each other across this lone and level triangle, one side dark, another light, and the third grey.

Who, then, do we find on the opposing sides in this end game? On the dark side, we find, as we did last Sunday, the likes of Hot Burning Coales, pro-government, pro-competition, pro-private sector and so pro-reform. Their strength is that they are aligned with government, and government with them, but their evidence is blown, and their arguments in tatters. Neither stridency nor volume could save HBC’s case for the reforms, as they wilted and folded, a styrofoam cup of competition coffee microwaved in the radiant beam of Evan Harris’s glare.

On the light side, we have the true beating heart of general practice, a gentle and benevolent practice; practice that suffereth long, and is kind; but not puffed up. It is the side on which general practice thrives as a local and much loved cottage industry; a benign industry where the owners tolerate the pains of running a business for the precious gift of independent self-employment. This is the general practice that the British people have known, and still love and cherish, from the glens of Tannochbrae to the light glowing in the grime of Cronin’s Citadel; medicine at its very best.

The dark side and the light side are evenly matched in weight, on the right and left side of the triangle, but the longest, and base, side of this triangle, for in Dr No’s daydream it is a wide flat isosceles triangle, has ranged along it the grey majority of general practitioners. These are the hollow men, and the stuffed women, leaning together in greyness, heads filled with straw, that yet in their numbers and mass hold the power to decide the fate of the government’s health service reforms. For it is this grey mass of GPs, and this grey mass alone, that has in its gift the power to make or break the reforms. They are the pawns, the foot soldiers, who will – or, if they so choose, will not – carry out the will and command of the government’s reforms.

The Red Queen of the grey side is Dr Clare Gerada. For some time, Dr Gerada has rallied her grey pawns, and led them in growing opposition; but more lately she appears to have been overtaken by frequent bouts of twitteritis. That is no way to win a game, be it chess or any other. Dr No believes the time has arrived to commence the end game: the grey side must now to join forces with the light side, and so square the triangle, and in their joint weight move to check mate the dark side, and with it that blasted bill. If not, we may soon find of general practice:

Nothing beside remains. Round the decay
Of that colossal wreck, boundless and bare
The lone and level sands stretch far away


Should GMC be alerted>
Dr Coales' assumptions about the qualification and eligibility of the current President Iona Heath were incorrect. Dr Heath passed the MRCGP in July 1981 and furthermore received the College’s prestigious Fraser Rose Medal, awarded annually to the trainee who scored the highest marks in the College examination. She became a Fellow of the College in November 1992. Dr Heath was elected to the post of President and took up her role in November 2009.

An apology from Dr Una Coales and a statement of fact
In response to an erroneous statement made by Dr Una Coales in her blog and posted on her website between 26 November 2011 and 2 December 2011, Dr Coales apologises and has agreed the following statement of fact with the College.

Has anyone got what she wrote?

Revalidation-sceptic Dr Una Coales is battling marketisation-opponent Dr Helena McKeown and three college educators, Professor Nigel Mathers, Dr Steve Mowle and Dr Janet Hall, for the job. The vice-chairman will serve under Dr Clare Gerada when she takes over as RCGP chairman in November.

Coales is a Locum GP. Locum?

Family practice is a better description than General Practice from my experience. The traditional family doctor committed him or herself to a life of service in a community and the memories are inter-generational. In my own practice between 6 doctors there is over a century of committment. Committment is anathema to the politics of consumerism and choice, innovation and 'creative disruption'. The relationship we have with our patients is more like a marriage -good times and bad, negotiations and compromises- than a contract, to be broken at the first signs of dissatisfaction.

The grey and the black sides of the triangle are changing the committment and long-term relationships that characterise what is best about family medicine, into short term contracts, not only between doctors and patients, but between the dr-preneurs and their dr-workers.

The BBC could do worse right now than revisit Tannochbrae and show the whole damned series of the original Dr Finlay's Casebook on a nightly basis.

The politicians and the members of the medical profession cuddling into them could do worse than watch every single episode and remind themselves what family medicine ( I agree with JT) is really about. Some things don't really change that much.

But then the economists and entrepreneurs will consider this witch to be a crazy old bat who is incapable of "change." For "change" is the air that they breath. Changing patients into clients. Changing clients into commodities. Changing commodities into pounds, dollars and euros.

Read this:

According to Andrew Marr, the IEA is "undoubtedly the most influential think tank in modern British history".

There are so many games that impress us and help to relax. This is what Dr No find with the chess like game. Thank you for sharing the life experience of Dr No and I love reading the article about him. Good luck.