The NS Interview: Clare Gerada, physician

“This reform is so large you can see it from outer space”

What are your fears for the NHS right now?
Two things: the NHS reforms and the role of general practice within these reforms. Like the whole of the health service, general practice is so stretched and overworked. I worry about the effect the reforms are going to have on how GPs are perceived by our patients.

Did you always know that once the coalition was elected, this was going to happen?
No, because, like others, I heard David Cameron say "no top-down reorganisation of the NHS". I was so relieved, because I have lived through 15 reorganisations. Each causes a hiatus, demoralisation; we lose staff and we lose relationships. For the past 20 years we've had the encroachment of the market, but I trust doctors and we were evolving quietly.

Does it feel like a betrayal?
I was amazed at it. This reform is so large, you can see it from outer space. It's about dismantling the architecture of the NHS.

How are these particular reforms different?
If the secretary of state is no longer responsible [for the NHS], they will only have to appear once a year to give a sort of "state of the nation" of the NHS. People have always said the secretary of state shouldn't do micromanagement, but for £120bn of taxpayers' money, somebody has to be accountable to parliament.

Is that an abrogation of responsibility?
The NHS is our NHS. It is one of the last things that we as the people - the taxpayers - own, and by owning it, our Health Secretary and our parliament are responsible for it.

What will the effect be?
Those who are least able to survive will be swimming against a tide: not just patients, but doctors, too.

Do you think patients are going to suffer?
We've got three big things going on at the same time - a massive reorganisation of the health service, alongside a serious financial situation, alongside the NHS having to make £20bn efficiency savings. So it is difficult to say which one is going to cause "X, Y, Z", but certainly patients are going to experience longer waiting lists; they'll see less choice available.

In what way?
There has to be less choice because there are fewer resources. I can't understand how you can have free choice in times of recession. When I started in general practice you could go anywhere. In time, you will see fewer services being provided by "the state", the NHS free at the point of use. Some treatments will still be available, but beyond that you'll have to pay for it all, co-pay or take up co-insurance.

You've spoken out against performance-related bonuses for GPs. Why?
In the [reform] bill, the government is suggesting that GPs be rewarded for keeping in budget. There is no problem in GPs having an incentive to practise good, evidence-based medicine. Where it becomes a step too far is where we are rewarded for keeping patients out of hospital. Because you have to trust me, you have to trust that I have stopped you from going to hospital because it is in your best interests, not because I am going to get £10, £15, £20 or whatever it is. And that begins to distort the doctor/patient relationship, which has to be built upon trust - otherwise what's the point of it?

Is the NHS unsustainable?
I don't think people realise that the average cost each GP gets to look after you per year is £70 per patient, which is less than you spend to insure your . . . hamster or whatever. So the NHS is incredibly cost-effective.

How does the NHS compare to other countries' health-care systems?
The government always brings up Singapore. A country where they still publicly cane people is not a country I would like to be equated with. The other country is France. France spends considerably more money on health. And yet its outcomes aren't considerably better.

Being a doctor is in your family, isn't it?
My father was a GP in Peterborough, which had the biggest Italian community outside Italy. He came from Malta and spoke fluent Italian, so he was the GP for all of these Italians. I learned to love medicine through him; he was the most extraordinary GP, doing long hours, going out in his pyjamas in the middle of the night - taking me on his home visits. He taught me some really simple values of medicine.

Do you vote?
I do, because women lost their lives in order that we can vote. We owe it to them, even if you scribble across the ballot.

Are we all doomed?
Gosh, I ask my sons that sometimes. I say to them, "Do you worry about global warming?" And their response is: "Oh mum, we're intelligent enough that people will find a solution to this." Of course we're not doomed. People, to me, will always do that right thing.

Defining moments

1959 Born in Nigeria; raised in Peterborough
1983 Graduates in psychiatry from University College London
1991 Becomes a GP and partner in the Hurley Clinic on a council estate in south London
1993 Sets up Consultancy Liaison Addiction Service, supporting GPs caring for drug users
2000 Is awarded an MBE for services to medicine for substance misuse work
2010 Is elected chair of council, Royal College of General Practitioners