As the 1990s loomed and the Thatcher era was drawing to a close, we witnessed one of the many failed attempts to ‘sort out the NHS.’

GP’s contracts were to be drastically changed without their agreement. The ‘new contract’ was initially greeted with horror by the British Medical Association on the basis that it would constitute a step towards privatisation of the NHS. The overall strategy was to create an “internal market” within the NHS, introducing a purchaser-provider split … so health authorities became purchasers of services from hospitals, which were then transformed into independent trusts. GPs could become ‘fundholders’ and purchase services.

This may all sound rather distant and irrelevant but it had significant knock-on effects for SWF. It also significantly affected me in that I became involved in a national campaign.

The BMA vehemently opposed the proposed changes, arguing that efficiency could not be achieved through competition and market forces. They argued that the internal market would undermine the NHS’s commitment to providing universal healthcare based on need, rather than market forces.

GPs warned that the ‘new contract’ would spawn mountains of mindless paperwork, new commitments and running pointless ‘tick-box’ health promotion clinics (which were soon dropped as they proved to be a waste of professional time and taxpayers money.) It was clear that one major casualty of the new system was going to be the confidentiality of patients medical records … which had hitherto been ‘the cornerstone of general practice’ given that patients had to be sure that what they told their doctor in confidence would be treated with respect. This laid the ground for me conducting another battle with the NHS … of which more later.

Another criticism was this was an untested policy. In the clinical arena there are rules designed to protect patients. For example, I wouldn’t have been allowed to invent a new drug and start trying it out on my patients. There would have to have been extensive trials first that ensured it was both safe AND effective. No such restrictions apply to politicians. however. They can have a ‘back of an envelope’ idea and roll it out nationwide in next to no time … which is a recipe for chaos.

In 1990 I wrote: “Looking to the long term it appears that the morale of the Profession will be severely dented by the new contract and, as a consequence, older GPs will be retiring early, GPs in their middle years will be ‘diversifying’ and young doctors will be discouraged from entering general practice” This is, of course, exactly what has happened.

One Essex GP fundholder said he planned to send those of his patients who were in need of dermatology referrals to Harley Street in a Bentley. Whether or not this came to pass, it was clear that, if some patients gained, others would be losers. In other words it would result in ‘a two tier health service’

The BMA mounted a costly campaign against the imposition of the new contract. There were articles in papers, interviews on TV and radio and posters on billboards. Then, suddenly, it meekly gave up the fight. Many doctors were furious and one consultant (Prof Harry Keen) and a bunch of GPs (led by me) decided on legal challenges. We got a fair amount of coverage in the national press. I asked Lord Denning (hitherto Master of the Rolls and described by Margaret Thatcher as “probably the greatest English judge of modern times”)  for an opinion – which was hopeful. We received overwhelming support in an attempt to have the imposition of the contract judicially reviewed but were thwarted … in no small part due to the fact that we were not supported by the BMA. Needless to say the contract didn’t last … although some of the damage it caused lives on,

The ‘head honcho’ of our bit of the NHS authority (the Essex Family Practitioner’s Committee) threatened to “kick” GPs who objected to the changes “from one end of the County to the other.” Needless to say my actions didn’t meet with his approval and this would have consequences .., of which more later!

All this ‘UK-wide’ activity didn’t mean that there weren’t continuing attempts over the years to improve the healthcare situation in SWF. By way of an example here’s a short video (recorded in glorious ‘Shakyvision’) showing potential sites for additional healthcare facilities – the objective being to bring services closer to the people who need them. The video link is: https://youtu.be/zCNxmKScejk It is surprisingly relevant today in that, as a bonus, it shows the number of parking spaces there were in a town built in the age of the automobile. Contrast the situation then with what’s happening now … a concerted attempt to ensure the town has less parking places than those that date back to a time when we were ruled by Rome.

Dr John Cormack

An assortment of newspaper cuttings from this era can be found at: https://mega.nz/folder/WYUAxLRS#StDqjrBZ77n6iLiCyRwYFA