Lets have LESS choice, not more

I may not be quite up to speed on this one, as I am actually in California, mugging up on the pre-circulated  papers for a conference on Roman sarcophagi that's starting tomorrow. But so far as I can gather from internet, Andy Burnham has decided to scrap GP catchment areas and say we can all choose our GPs from wherever we want -- near home, near work ... or anywhere. If we particularly wanted that excellent man in Manchester, while we lived in London, then so be it. You can read the full speech here.

The argument (as always) is that choice will "drive up" standards. But I have never quite seen why that is so.

I can see that some tinkering with GP systems might be in order. Students, for example, often live in two places (their university during term, their old home during the vacation) and there seems to be no easy way on the current rules of coping with that. It's also the case that the usual GP surgery opening hours dont fit with most of our current working patterns (but most surgeries are now doing early and late shifts to cope with that).

But CHOICE is a dangerous mantra, and usually a cheap substitute for serious improvement. As with primary schools, or hospitals, I don't particularly want choice -- I would prefer good local services, so that I don't need to think about choosing, or wondering if the grass in another postcode is greener.

For a start, most of these choices are not in practice available to most of us. Remember the idea that we were all going to be able to go and get our operations done anywhere in the EU if it could be done more quickly than at home. I wonder how many Grannies did end up flying to Bilbao for their hip replacements (and if they did, I wonder whether being ill in a foreign language they didn't speak, without their usual support networks around was actually good for recovery).

Besides, more choice for some always ends up as being less choice for others. We cant all enrol in the most popular doctor's surgery. So what happens to those of us who get left in the sink practice? And how, on these proposals, is the sink practice expected to improve? How does choice help? The basic rule of thumb is that choice simply puts more power and privilege in the hands of the articulate and well-resourced.

Of course, when we hear these proposals we always think that it us who will be doing the choosing (just as we always imagine that it would be our kids going to the grammar school if they were re-invented). That's why they are a low cost popular move for a politician, or a party, needing all the votes they can get. But the truth is that many of us won't have a real choice (just as 80% of our kids would go to the reinvented secondary modern).

We also tend to forget what kind of lifetime medical needs we shall have. The choice of a doctor near your work might be a fine idea if you are young and most of your medical needs can be met with one visit to the doctor and a prescription. But what if you need a home visit? What, in other words, if you are old and chronically sick? Well. ok, perhaps you could re-register then -- if you could find a good practice to take you on. There will have to be some cap on numbers, so presumably those sink practices will end up filling up their numbers with the poor, old and chronically sick who cant enrol elsewhere. Some choice.

And what has happened to the idea of continuity of care? One of the things I like about my GP is that I've known him, and dealt with him. for 25 years or so (in fact, we're growing old together). I know that that is a privilege few patients now have -- but it's that, not some phoney choice, that I would like to offer to more people.