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I'm a GP registrar – here's what's going to happen to the NHS now.

Originally Featured in The Independent 17 December 2019


It bears no repeating but the NHS is in crisis – and there are no signs that's going to change.


You may be forgiven for thinking this election began and ended with three words: “Get Brexit done”. But as an academic clinical fellow in general practice, I was left wondering: what does the Tory majority mean for the future of our NHS?

Somewhat buried in election coverage was the news this week of the longest A&E waiting times since records began – 12-hour trolley waits are five times what they were in 2012. This on top of the worst cancer referral and treatment waiting times on record. It’s been repeated so many times it’s almost lost its meaning, but the NHS is in crisis.


The new Conservative government might pretend this is their inheritance, rather than their fault. But with the current cabinet and PM having voted for every budget and NHS policy in the last decade, they are squarely responsible for this crisis.


So what can we expect the new government to deliver? In the immediate future, no immediate cash injection has been promised. The NHS’s annual winter crisis has already begun, and we can expect it to be the worst on record.


The 2019 Conservative manifesto was notoriously light on detail. Pending “business case approval”, at least six major new hospitals have been given the green light, to be built by 2024. Up to 38 further hospital projects (which includes a “variable” number of community hospitals) have been given initial funds to draw up plans for builds between 2024-2029. All of which to say is, there will be no widespread boost to facilities any time soon, if at all.


The Tories grabbed headlines with promises of 50 million more GP appointments and 6,000 more GPs. For me, these words rang particularly hollow; we’ve heard them before. In 2015, 5,000 more GPs were promised by 2020. Today, 1,608 fewer full-time GPs are now working than in 2015. It takes 10 years to train a GP, so it is very unclear where these new colleagues of mine will come from; two in three EU doctors are considering leaving the service, while nearly one in two GPs plan to retire in the next five years.


For myself and others on the NHS frontline, the Tories’ promises are of no reassurance. We have witnessed first-hand the impact of nine years of austerity on our health service. Watching the campaign, we couldn’t understand the duplicity of politicians proposing to fix a system they have broken, and done nothing about for so long.

A major moment in the election campaign was the revelation of redacted US-UK trade documents that showed that the US has been taking a particular interest in the NHS, specifically the price of drugs and length of patents.


The idea that one of the biggest sectors of the US economy would not be included in UK-US trade talks post-Brexit is ludicrous. Indeed, the Tories have a history of offering the NHS up to the US. The now-defunct Transatlantic Trade and Investment Partnership between the EU and the UK, which David Cameron enthusiastically backed, included the potential for US-healthcare companies bidding for and suing for state healthcare contracts.

Within the 450 pages of redacted talks was the suggestion that unless explicitly “negatively listed”, the NHS would be on the table in a trade deal. In other words, we cannot assume the NHS is safe until, well, it is.


Meanwhile, our NHS relies on the immigration the Tories are likely to clamp down on, both in Brexit and beyond. One in four doctors and one in six nurses currently in the NHS were trained abroad. Over 50,000 NHS nurses and doctors are from the EU. Since the referendum, EU nurse recruitment has essentially flat-lined, with a 96% drop in EU nurses registering with the Nursing and Midwifery Council since the Brexit vote.


With the Tories proposing an Australia-style points-based immigration system, it remains to be seen whether they will be able to make good on their manifesto pledge to recruit 12,000 new nurses from abroad by 2024. Not even NHS staff are currently exempt from the health service's £600 annual overseas surcharge, and its planned increase will be another reason to turn away from the UK as a nursing immigrant.

Overarching all of this, of course, is the climate crisis, “the greatest threat to health of the 21st century” and one which – according to last year’s groundbreaking IPCC report – we have only ten years to act upon. Despite the government declaring a climate emergency last year, the Conservatives have only committed to net-zero carbon emissions by 2050 – incongruent and insufficient for the scale of action required. If they continue in this vein, there will be no planet, let alone an NHS.


Ultimately, the Conservative manifesto is sparse. It’s difficult to tell what’s really been promised to the NHS, or how it will be delivered. What concerns me as a GP registrar is that it has been written by the same people that created this crisis, people with a long track record of breaking their promises and a callous disregard for the consequences of doing so.


In short, I am heartbroken – but I am also hopeful. A silver lining throughout this election campaign has been the unshakable commitment shown to the NHS by its staff and users. In the words of Welsh Labour politician Nye Bevan: “The NHS will last as long as there are folk left with the faith to fight for it”. This fight is needed now more than ever, and I have faith that we can win it.


Dr Rita Issa is an academic clinical fellow in general practice in London.


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