samit dawlatly gp partner at Jiggins Lane Medical Centre in Birmingham

Is this the real life? Is this just fantasy?

Once upon a time, in a reality not very far away, there was an ancient town. In the old days all the citizens had to fend and provide for themselves. The poor were often left needy and many died well before their time.

About 60 years ago the benevolent Sir Bevan of Whale hatched a plan to provide sustenance and help to all the citizens of the town. He set up the Notional Healthy Service. The way it worked was that the citizens of the town who could afford to, paid tax to the local council, that then organised healthy services for all.

The birth of generic practices

The majority of these services were delivered via a collection of generic practices. The healthy services took the form of health foods used by the people. As the taxes continued to be collected, the money was spent on all day buffets. Open access, free to all who were hungry or believed themselves to be hungry. The generic practices would load up their trestle tables, open the doors and allow the population to help themselves. First come, first served. They even went out to the homes of the housebound to deliver parcels of health food.

Before the service was set up, there had been a war which affected all parts of the town. The population had to live through an age of true austerity. They had become used to looking after themselves and only used the services when they really needed them. In those early days of the services there was only meagre fare on offer anyway, nothing fancy or complicated and a very limited menu.

Then everything changed

As time went on the range of health foods that could be prepared went up exponentially and more and more tests were needed to decide who needed which health food. The population became used to turning up at the generic practices for more and more issues, many of which were only tenuously related to food. But the value of the health food slowly seeped into the population, who became older, fatter and more reliant on the handouts from the generic practices.

It became clear to the poor souls running the over-run practices that anything that is free cannot be valued, but they were trapped in their role. They had a contract with town council to provide a smorgasbord of health delights, the range of which changed and expanded each year, for the same budget. They had little power to negotiate their contract, they were vilified in the town paper for being too rich and not working hard enough. They had grown accustomed to caring for their fat, needy population. Changing the system would affect the population, destabilise the council and cast the generic practices as the evil who removed the right to free health food.

Back to the real word, or so it seems

So, no-one did anything, except organise and reorganise the committees that helped run the generic practices. Pushing them together to provide a multi-national cut-price buffet, along the lines of Around Your Health in 80 Plates. In the latest development the town council published its Sustainable Transformation Menu. The generic practices have had little say over this, though any new refurbishment money is reliant on the changes in the menu, which also stipulates how the practices are organised with relation to health food shops and specialist out of town centres.

There is much wailing and gnashing of teeth as the vision of Sir Bevan is being eroded by the expectation that more health food will be produced for less money and likely to be served up less practitioners who retire or go work in a faraway village, Dow Nunder.


Samir Dawlatly is a GP partner at Jiggins Lane Medical Centre in Birmingham. He is part of the Management Board of Our Health Partnership, the largest GP super-partnership in the UK, and was recently elected to the Birmingham Local Medical Committee. He is also the co-clinical director of “QCAPS”, a peer-review referral quality improvement scheme for the Northfield Alliance.

He blogs occasionally, including for outlets such as the Huffington Post. He has been known to write and record songs and occasionally go rock climbing all while trying to be a good husband and father.


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