10. How can they be so stupid? Wishful thinking….


If you are offered something attractive by someone, you naturally hope that it is what you are going to get. You hope it ‘will come true’, that it will not be illusory.

The property bubble and the disastrous crash in 2008 was at least in part built on ‘wishful thinking’. Bernie Madoff’s ponzi scheme went on as long as it did at least in part due to ‘wishful thinking’ on the part of his investors.

If Andrew Lansley is going to offer you choice, why turn him down?

‘I mean choice, at no cost, it can only be a good thing, right? We have the Department of Health’s assurance on this, right? I’ve read the leaflet, what’s not to love about it? Sure, I’ll go with choice, it’s a no brainer.’

6. How can they be so stupid? Stupidity-to different degrees, at times grotesque


The Oxford Dictionary of English has next to nothing for stupidity. For ‘stupid’: lacking intelligence or common sense; dazed and unable to think clearly: apprehension was numbing her brain and making her stupid

lacking intelligence: yes, this is relevant

lacking common sense: yes, definitely

dazed: they should be

unable to think clearly: yes, many examples of this


5. How can they be so stupid? Ignorance, wilful and unwilful


With the issue of GP practice boundaries, there is in general a very limited  understanding about general practice actually works, about how good quality general practice works. Even our hospital doctor colleagues often do not understand how it works.

Good quality British general practice is a very complex technology which serves local communities in geographical areas. You need to have an understanding of this and how it works. Otherwise, you are ‘ignorant’.

A GP colleague of mine has been to a number of events organised by the Department of Health in recent months. She has been struck by how ignorant the people from the Department of Health are about how general practice works, how general practitioners work, how good quality British general practice works.

‘Wilful ignorance’: don’t confuse me with the facts.

My initial comment on Government pilots on boundary-free general practice: is it a fraud?


The Government and Department of Health recently announced pilots for commuters to be able to able to register with GP practices near their place of work. Tower Hamlets, City and Hackney, and Westminster are amongst the pilot sites.

There was an article in Pulse this past week which quoted some of the misgivings of affected LMCs (Local Medical Committees).

I posted the following comment to the Pulse article (as well as the similar story in GP Online):

I have been thinking about this issue for some time now. I know that a minority of GPs are ‘excited’ by it, but I am not clear why. I practice in Tower Hamlets; when people move away, it becomes in many ways unworkable to continue to look after them as patients. This has been our experience. Yes, there are some groups of patients who need a workable solution: use a sensible methodology to find that solution, but be clear-headed and honest about the risks and problems.

I fear that this whole ‘Choice’ issue is just a Trojan horse. The Choice offered is an illusion, and hidden within this horse are all sorts of problems, unintended consequences, anomalies. I hope in the coming months this issue will be aired, the deceptions made clear. It is essentially a fraud. The ultimate aim (covert) is the de-regulation of English general practice. De-regulation in the sense that financial services were (under concerted pressure from lobbyists) de-regulated, leading to financial gains for some, but (undeclared) risks and subsequent losses for many clients. General practice without boundaries is, I think, the Holy Grail for some. But it won’t give us good quality, community based, integrated, family medicine. Indeed, it will undermine it.


This story will develop in the coming months, as the practicalities begin to bite.

Essential question: does it work?


I remember when our kids were young I bought a book called The Way Things Work. I reproduce the cover here.



I’m not promoting this book. It’s just that I was thinking about this issue of ‘how things work’ yesterday and thought of the book. There has been a great deal of discussion and debate in the past months on the so-called NHS ‘reforms’. On the whole, there has not been much detail about how a given policy is supposed to work, or evidence that it does work.

My particular issue is the proposed policy to abolish GP practice boundaries. When this first came to my attention about 2 years ago, I was appalled. Why? Because I know from experience that it does not work. How do I know? Because we regularly have patients leave our area and move away, sometimes only a mile or two. Many try to stay on as patients, and when we catch up with them, we ask them to get a local GP. But we have to deal with these ‘non-local’ patients for a time and our experience has shown that it works poorly, and is sometimes actually unsafe. So in essence we have 20 years experience with this and in that sense we have been a de facto pilot site for this policy.

In March 2010 I emailed Andrew Lansley as I knew he was keen on this policy, and was in fact chastising Labour for not having implemented the policy themselves. I felt I had to ask him to show that he had a grasp of how general practice works, and that he had done a robust risk assessment. Click here to see that email exchange.

There is no evidence that Andrew Lansley did a risk asssessment; in fact, his chief of staff says in one email that she could suggest that he do a feasibility study. Now it seems to me that if you are undertaking a project of any complexity (and general practice in England is a technology of high levels of complexity) that you do a thorough assessment:  1. you check how it works; 2. you model how you would like it to work; 3. you check for unintended, unwanted effects of your proposed changes; 4. you test it, and evaluate how it works.

And you do this before you launch this as a policy.

If Andrew Lansley or any other Government minister, or MP, or Department of Health spokesperson thinks that this is an unreasonable or dispensable requirement, please let me know.


For a successful technology, reality must take precedence over public relations, for nature cannot be fooled.   Richard Feynman