I am reading an interesting book, The Checklist Manifesto by Atul Gawande. He is a thoughtful surgeon, and so is concerned with delivering quality healthcare. Chapter 3 of this book looks at how buildings are built nowadays, the complexity involved, and how that complexity is handled. He follows a structural engineer whose firm builds very large developments. These are complex, and sophisticated processes needed to make sure that these buildings function as planned and do not, at worst, collapse. Meticulous planning and implementation is needed, and they have developed intelligent strategies to achieve their aims.
So when I turn to the issue of ‘choosing your GP’, it seems to me that there are questions we need to ask. Given that primary care is a complex system, how will this proposed policy impact on its functioning? In what ways will it make the system perform better? In what ways will it impact in a negative way? How does the complex system of UK primary care work at present? What does it do well? Why are other nations envious of it? What does it cost? And so on, there are numerous other questions that need to be asked.
And how will this proposal, this idea, impact on this system? How will it work? What improvements might it bring? What negative, unintended consequences might occur? And of course, to think about this, one would have to model it: chart the consequences of various steps in the change. If we do this, what will happen? And if this happens, what impact will this have? And so on.
In my email the Andrew Lansley what emerged is that Mr Lansley and his team had not done any assessment of this issue. They liked the idea, but they had not tested it in the real world, in the actual world. If architects and structural engineers used this approach to buildings, they would collapse.
Try to find any ‘blueprint’ for this building that is the ‘choose your GP’ policy, showing the plans, the complex steps needed to implement this, the cost-benefit analysis. Ask the Department of Health for the plans. I predict they don’t have one. They will make it up as they go along.
You as a member of the public will of course welcome the idea that you can choose whatever GP you wish to in England: that can’t be a bad thing, of course you are for it. But then ask yourself the question: would you want to go to the 54th floor of a building that had not had rigorous, systematic planning to ensure that it would function properly, and that it not fall over in a strong winds?
Mr Lansley’s vision (and, to be fair, Mr Burnham’s vision before him) has unstated, un-thought of costs and risks. And you, members of the public, journalists, politicians, are not even asking to see the plans, asking to speak to the structual engineer who has approved this plan. If you were to ask, I think you would find that they have not actually employed a structural engineer.