I’ve talked about the problems we had with maternity services, and antenatal care in particular, at one time – and mentioned that we’d had to hire our own midwife to get us through a very sticky patch.

I was reminded of this by the news that 14 hospital trusts are to be ‘looked at’ in an urgent national investigation conducted by Baroness Amos. This follows a record level of legal claims resulting in the NHS facing a £27bn bill for maternity failings in England.

There is a universal problem – and it’s one I faced throughout my time as a GP … the NHS ‘culture’. If there’s a problem, management’s first instinct is to play it down, haul up the drawbridge and pour boiling oil on anyone who doesn’t hunker down with them. Contrast this with the aviation industry’s safety culture whereby all aviation accidents and incidents result in a thorough investigation, swift action based on the findings and the retraining of aviation personnel in order to best protect passengers. One GP (Dr Lynette) feels so strongly about the contrast between the ‘we will learn from our mistakes’ statements put out by the NHS and the fact that nothing much seems to improve that she has released a ‘ranty’ video. (Our midwives do their best but it’s reckoned that, in England, we desperately need around 2,500 more full-time equivalent midwives to cope with demand.) Needless to say, Private Eye’s ‘MD’ also has a dim view of the NHS’s safety culture.

When the old Mid Essex & S Chelmsford PCT was finally put out of its misery, it was subsumed into a new organisation … Mid Essex Primary Care Trust (aka NHS Mid Essex). This was headed by Sheila Bremner who, in a former life, had been a physio – so it was hoped that, having had clinical experience, she would be more sympathetic than the old regime to the wants and needs of patients. This turned out to be overoptimistic as it soon became apparent that she was far more concerned with the wants and needs of Sheila Bremner.

The profligacy of the Maldon and S .Chelmsford had left the new PCT in a difficult financial position. Nevertheless it had to follow orders. Lord Darzi (a brilliant surgeon who seemed to know nothing about primary care) decreed that walk in services should be set up circa 2009. These ‘Darzi Centres’ would be open 12 hours a day – so, for patients, this was an attractive idea. As ever, though, the devil was in the detail.

I made the point back then that it would be far cheaper, more efficient, and much fairer (given that those living close to the proposed site for the Springfield Walk-in Centre would have a considerable advantage) to give the funds earmarked for this project to GP practices to enable them to group together in order to provide a similar service from a group of preexisting premises – their practices. This would achieve the same objective – taking the pressure off A&E and providing a more accessible service for patients – and it would be far cheaper as it would obviate the need for capital outlay. Moreover, if it didn’t work it could easily be adapted until it did … or disbanded at no cost to the NHS/taxpayer if was underused or served little or no useful purpose.

Distance has been shown to be a barrier to the ability to access healthcare – which is why this solution would have had advantages over the ‘single hub’ solution for patients.

The PCT, however, had been told to set up a ‘Darzi Centre’ so we were faced with the usual NHS ‘public consultation’ procedure whereby you decide what you’re going to do, then you consult the public, and then you do exactly what you planned to do in the first place. In order to ensure the obligatory consultation produced the ‘right’ result the questions were carefully framed. The public was basically asked: Would you like a fantastic brand new walk-in centre with all the bells and whistles? Needless to say, many of those who responded said: “Yes, brilliant idea … let’s do it immediately!” There was no mention of cost, of its effect on general practices or the local NHS economy, and there was no evidence produced that it would achieve its aim of lessening the pressure on A&E. In other words, the public was not given the information required to reach a balanced decision. Even so, there were seemingly more naysayers than the PCT were comfortable with. An Oxford Uni alumna who looked at the ‘voting figures’ in the public domain felt they didn’t quite ‘add up’ so we were reminded of Joseph Stalin’s maxim: “Those who vote decide nothing. Those who count the vote decide everything.”

Irrespective of what went on behind the scenes, the scheme went ahead – and the PCT chucked shed-loads of money at it whilst many general practice patients in the Mid Essex PCT area were starved of resources. As predicted, it never achieved its primary objective – to relieve the pressure on A&E … but more of that later.

Dr. John Cormack