Divide and Rule- Dilution of the Health Service

It's Jan 5th, just five days into New Year and I'm feeling depressed already. No, it's not the lousy weather that's doing it, and it's not the excesses of Christmas, although I have been feeling a little tender and tight around the waist. It's the mud slinging fight that has erupted over at NHS Blog Doctor between doctors and nurses, that's making me feel down. And it's happening because the government is playing an old and very effective game with the NHS - divide and rule through dilution.

Perhaps the best comparison of what is happening in the NHS, is what happened to teaching. Before WWII, a teacher in a secondary had to be a university graduate. If they wanted to teach Higher classes, they had to be an honours graduate. After 1945, this changed. Graduates with a BA were allowed to teach further up the school. This was good for them, as it gave them more job opportunities and possibilities for promotion. But it caused division, because it meant that there was no incentive for a graduate to study for honours; those who had studied longer gained no advantage. At the same time, the teachers' pay was going down. If someone wasn't so well qualified, then why pay them a good wage? It took until 1964, for the teachers to pull together and stage their first strike, and by then the game was a bogey. Honours graduates had gone elsewhere into business, medicine and law, where the pay was higher, and teaching lost its place as the top profession to be in. 'Those who can, do; those who can't, teach,' was said of those who went into teaching. It was what you did when you couldn't get a job in another profession. Now the use of classroom assistants to take classes when a teacher is off, is another step down the rung and I'm sure we are going to hear more about it.

The same thing is happening in medicine. The introduction of the nurse practitioner and salaried GPs is causing division amongst the profession. Nurse practitioners were mooted as highly trained nurses who could take over some of the routine work in minor injuries in hospitals, or in GP surgeries. In reality, what is happening is that they are replacing GPs, especially in health centres. Instead of having an appointment with a GP, you have an appointment with a nurse practitioner. That's ok if you need something bandaged, or a blood test done. It's not ok if you are presenting vague symptoms and you need a diagnosis of illness.

Again, salaried GPs are causing division. A salaried GP is a GP recruited by a private healthcare company, running a health centre. They get paid much less, and have to abide by the rules of the company. They also do not come under the jurisdiction of the General Medical Council. They are leaving other GPs out of work, who are too principled to work under these conditions. Yet at the same time it's hard to resist. If you are a young doctor, and your local NHS has allowed a private company to do recruitment of staff, what else can you do?

It's one of the oldest governmental tricks. Pay some more, pay some less and let them fight. Divide and rule.

Guys, you need to stick together. You need to get involved in politics, get your people into local government where you can oppose much of this and drive some stakes into the ground now. You cannot indulge in mud-slinging just now and hope it all comes right later. It's not going to.

Nurses, doctors, nurse practitioners,salaried GPs unite! You have nothing to lose and everything to fight for; the professionalism of medicine,the ethos of patient first and the NHS as a public service. No pressure.