Mr Blair must recognise before it is too late that this is a political, economic and cultural faux pas.. Recently in my hospital I’ve been struck by the number of patients, newly arrived in the area, who say they have been unable to register with a general practitioner. They are not the kind of patients with whom, alas, we are all too familiar: the patients who are so rude or violent that they are passed from surgery to surgery like packages of TNT, each doctor taking an unwilling three-month turn to provide them with medical care. On the contrary, they are perfectly respectable and decent patients: there are simply not enough doctors to go round.
Is this a problem or is it a crisis? Is there realistically a prospect of large numbers of people going without primary medical care? And if there is a problem or a crisis, who – or what – is to blame?It is unlikely that carts will have to be sent round our streets, as during the Great Plague of London, picking up the dead who have died overnight through having been unable to find a general practitioner to look after them. There are always our overworked casualty departments, which large numbers of people already use as their preferred source of primary medical care. The seriousness of the problem depends upon the scale by which you measure it.The GPs are caught in a situation in which it is impossible that they should answer all the demands made on them at once. The Government has tried to divert patients from hospitals to GPs – in the hope of reducing hospital waiting lists, thus avoiding damning headlines in the newspapers – by offering GPs incentives to do more for themselves rather than referring patients to specialists.GPs now find themselves with responsibility for blood tests that were once taken in hospital.

They now run clinics for asthmatics, diabetics and other chronically ill patients. Some even undertake minor surgery; though the pattern of incentives is such that much of this surgery – for example on warts – does not relieve pressure on hospital waiting lists, because the patients would never have been referred to hospitals for surgery in the first place. Surgery on warts increases the GPs’ incomes, but it adds to the pressure on their time.Patients are, likewise, more demanding. They are reluctant these days to be treated as sausages being squeezed through a machine.

I remember 25 years ago being reassured by a GP for whom I was doing a locum that I would be able to finish his surgery in an hour. There were 60 patients, and the doctor for whom I worked never examined any of them, and clearly didn’t expect me to either.This won’t do nowadays, when patients grumble even if they have five times as long with their doctor. They expect to discuss their diagnosis and treatment, rather than blindly to follow hurried advice of a generic nature. Meanwhile, there is a growing shortage of general practitioners.

A large number of Asian doctors who came to Britain in the 1960s, and who often worked in the most deprived areas, are now at retirement age No one is rushing to replace them. Increasing numbers of doctors are choosing to retire the moment it becomes financially viable for them to do so. Between the pressures placed on them by the Government, and by the patients who come armed with information taken from the internet with a clear disposition to sue if not satisfied, medical practice is not much fun any more.For GPs to comply with modern standards, they should not have lists of more than 2,000 patients (1,500 would allow them to work at a pleasant, steady pace; they have up to 3,500 now). But the primary care trusts, like the family practitioner committees before them, are empowered to force doctors to take patients, if those patients cannot find another doctor.