The M Word Issue 7 - Dr Michelle Drage's latest personal briefing for practices on NHS reforms


Through the fog 


I felt it timely to send a beam of light out into the fog and try to illumine the way ahead for general practice. 


Big breath, here goes:


And in June 2010 all was rosy in the London GP Garden of Eden. Everyone knew his or her place. 6000 GPs and 1500 practice teams managed in the midst of all the challenges of a Capital city, to deliver high quality primary medical services for patients within ever tightening cash limits, 31 PCTs would be there to provide a lot less than they provided before while being unable to properly support practice based commissioning, and NHS London would be there to do strategic stuff like polyclinics, stroke, hospital opening and closures and promote competition.


Then came the Bill, and a fog descended.  Then a great pause came sucking up all that was ripening in the GP commissioning fields.   And then came a new way forward from the top of the NHS and the fog begat a right peasouper.  And it came to pass (not the Bill that is), that everything got gummed up by peasoup.   And there was a big gathering of all the Lords in parliament, and Lo, it came to pass that all was not good in the NHS and the workers summoned their leaders to rebel. And it was so. And the RCGP and the BMA and the RCN and all the other Royal Colleges united in defence of the NHS, and.......


Time passed .......


And passed .......


And the fog lifted.  And the workers emerged from their places of work.


And there were 31 CCGs and there were 6 clusters and there were 3 CSOs and there was 1 NCB London office. And the 6000 GPs and 1500 practices in London all survived the right peasouper and patients still came to the surgeries, and the workers still managed, in the midst of all the challenges of a Capital city, to provide high quality primary medical services to their patients. And everyone knew his or her place. And all was rosy in the London GP Garden of Eden.


You may have your own views, thoughts or comments on my passage above. If you do, please try to take a little time to feed them back to me at 


My best wishes

Dr Michelle Drage FRCGP

CEO Londonwide LMCs


PS - In case you missed it today (Thursday 1 March) the BMA called upon the Government to withdraw the Health and Social Care Bill and start a dialogue on an alternative. Read the full press release on the BMA website

Last updated : 16 Nov 2021


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