The government continues to push its quaint vision of local GPs doing local healthcare commissioning. Many who know rather more about the National Health Service than the government do have pointed out this is a non-starter. But let us imagine for a moment what might happen if all GPs did take on commissioning. It might go something like this:
Scene: Walmington-on-Sea Church Hall. Platoon drawn up, Mainwaring and Wilson face them.
MAINWARING: Right, Men. I’ve a very important announcement to make. (inflates chest) We’ve orders from the ministry to fix the NHS. Its going to be the next big thing. (inflates chest further, taps swagger stick on flipchart for emphasis) Its called Home Guard Commissioning. We’re going to show these Johnny-come-lately American chaps how it’s done.
JONES: Very good, sir, very good! I’d like to volunteer, sir, volunteer to do a spot of commissioning!
FRAZER: We’re doomed!
WILSON (slouching): Do you really think that’s wise, sir?
MAINWARING (to Wilson): It’s not a question of ‘is it wise?’, Wilson. It’s orders. For once, try to show some pride …
WILSON (musingly): I seem to recall only last week you warned us against pride, sir, coming before a fall and all that.
MAINWARING (reacting): Any more of that seditious talk, Wilson, and I’ll see you busted. (turns back to platoon). What we are going to do, men, is have a fête. Bunting, that sort of thing. We’re going to invite the local hospitals to set out their stalls, tell us what they’ve got to offer. We’ll inspect the goods, decide what we want, and place some orders.
GODFREY: Sir, do you think I could order a new truss? Ever since Dolly washed my last one, things haven’t been quite the same.
MAINWARING: What do you mean, not quite the same?
GODFREY: Well sir, I have to be excused more often.
MAINWARING: No excuses, Godfrey. Anyway, this commissioning thing isn’t about trusses. It’s about drugs, operations, that sort of thing.
WILSON: Operations, sir?
MAINWARING: That’s right, Wilson. Hernias…
WILSON: But I thought that’s what trusses were for, sir?
MAINWARING (glaring at Wilson): I’ve warned you Wilson…
Scene fades. Music over credits:
Who do you think you are kidding Mr. Lansley?
If you think we’re on the game…
We are the boys who will wreck your little plan!
We are the boys who will…
If rank and file GPs get hold of NHS commissioning, they’ll make the Home Guard look like a professional army.