In my view.
If it is true that "only Labour can destroy the National Health Service", as so passionately stated in a recent Journal article by Professor David Byrne of Durham University, then who indeed can save it?
Clearly not the Conservative Party, in the learned Professor's view, as they didn't even rate a mention in his impassioned plea of opposition to the dreaded concept of "privatisation" in the NHS.
He claimed that the health service, or indeed any not for profit service, worked a lot better than those for profit. He accused Labour of introducing the profit motive into the relationship between family doctors and their patients, and yearned for the days of his grandmother who was "a real Labour activist who knew what the NHS meant".
I would not like to argue with his grandmother, but I think the Professor is well off the mark. The Conservative Party introduced fund holding to General Practice, clear financial payments acting directly between patient and GP, which New Labour immediately abolished in 1997. As for privatisation, he clearly is unaware that the entire primary care service in this country is run by a multitude of independent, self-employed businessmen, sometimes known by their other title, General Practitioners, all of whom regularly turn a good profit from the NHS. Indeed, in the last few years, they've done particularly well. Some larger practices have profits well into six figure territory.
As a GP myself for over 20 years, I have developed a good understanding of the system, but also have a good understanding from the other side of the fence in my role in health service management over the last 10 years, thanks to New Labour and their insistence on the active involvement of clinicians in the management of the NHS through Primary Care Trusts. From this perspective, I can see that while the vast majority of my colleagues do an excellent job, the service we deliver remains inflexible and isn't always responsive to the demands of the new millennium. This is in spite of record levels of investment in the NHS.
The Professor goes on to criticise the notion that the contract for a vacant General Practice should be put out to tender (or privatisation as he thinks of it), preferring that the large sums of public money involved should be handed over, without any means of determining whether this represents value for money or what other services might be offered by different providers.
Perhaps this is what occurs in the ivory towers of planet university, but surely not on planet earth in the 21st Century.
Traditional General Practice, delivered by local GPs, remains at the heart of the NHS. It is clearly valued highly by patients and can deliver high standards. It needs encouragement and support to move forward, so it can stand up to the challenge of the future, not hide from it. It needs to deliver a wider range of extended services at times and in places that meet the needs of all patients. Managers, working with doctors, need to find innovative ways of delivering this for patients, not protecting vested interests including their own.
This is the real paradox that reform must deal with. Managers are responsible for running a large range of services themselves, as well as deciding who should run them. A huge bureaucracy and inertia has developed around the NHS as a result.
The time has come for a clear separation of roles. Decisions reached about what services are needed have then to be offered out to see who can best provide them, separating clearly "commissioners" from "providers" and thus ending the self interests that so often stifle change.
Everyone who works in the NHS makes some profit out of it. We just need to make sure that we know what we get in return. Let's not get stuck like dinosaurs on dogma about profit or private. Let's just make sure we get the best service for patients.
John Mackay is a GP in Sunderland and chair of Sunderland Teaching Primary Care Trust (TPCT) Professional Executive Committee. These are his personal views.