Dr Peter Moore: NHS at 75 - challenges as our beloved service becomes the sick patient

Happy birthday. The NHS was 75 yesterday (Wednesday, July 5). The Evening Standard headline ran 'State take over doctors, hospitals and dentists, free for all 1948'. Above the headline it pointed out that it will cost £152,000,000 a year.
Until 1911, GPs worked as independent businesses rather like the corner shop. People would visit the doctor and pay for treatment. There were some employed doctors, but most were independent. There was also no differential between hospital doctors and GPs. Many GPs also worked in a local hospital.
My grandfather was a GP in Newton Abbot but also an anaesthetist. His partner in the practice was a surgeon and together they carried out some fairly large operations at Newton Abbot Hospital.
Before the NHS many GPs were single handed and on call 24 hours a day, 365 days a year. As few working-class patients had access to a phone it was normal for the GP to be away some of the time with no on call cover.
In 1911, Lloyd George introduced the National Insurance Act when working people on a low income, nearly always men, could join a doctor’s panel and receive free care. Unfortunately, this meant that the service did not usually include wives and children. The NHS increased the 'panel' to include everyone.
The original plan was for all GPs to work from health centres and be employed by the government, but this was very unpopular with the doctors. It was an idea first proposed by Lord Dawson in a report in 1930. Would the Government take away their freedom to practice in the way they thought best and dictate treatment?
The final compromise allowed GPs to keep their surgeries as independent businesses subcontracted to the new NHS. And so new GPs had to buy into a surgery but, as the NHS paid a rent for the surgery, provided the rent matched the loan repayments it was affordable.
This was the system I bought into in 1981. It worked well provided the doctor remained at the surgery for 30 years. The problem today is that new doctors already have a large student debt and most do not want to commit themselves for 30 years. The world has changed.
It was also believed that the NHS would improve everyone’s health so costs would fall. What was not anticipated was the incredible progress in medicine leading to a massive increase in costs.
I worked for the NHS all my life and saw it as an old friend but tragically this dear friend is now struggling with poor morale, not enough staff and increasing demand. The founding principles of free to all based on clinical need, not the ability to pay are still vitally important. The NHS has become our religion.
The role of the NHS is to help prevent illness and, when needed, to treat the sick. But now the NHS itself is the sick patient.
A recent study of 19 developed countries by the King’s Fund found that the NHS lagged behind in almost every area. There are only three doctors per 1,000 people in the UK compared with Greece who have 6.3. The UK was also bottom in the number of MRI and CT scanners per person, second to last in hospital beds per person.
These figures are reflected in a higher number of deaths from treatable conditions such as heart disease and strokes, and below average survival rates for cancer.
There are plans to train more doctors and nurses but will this be like filling a bucket with a hole in the bottom? Working conditions and morale must be improved if the new staff are to stay. Improved morale will also lead to improved patient care.
We are lucky that, despite the real problems, the NHS staff are amazing. They need our support. Everyone loves the NHS but, unlike the John Lennon song, love is not all we need.