“Based on two documents presented by the author at the CCSC Meeting on Medical Chambers, 14th February 2002 at BMA House.

There are many reasons for the parlous state of the NHS today. Being the dominant healthcare provider in the country, it faces challenges many of which have only been addressed in a piecemeal fashion. Over some issues that confront the NHS, political ineptitude and the ponderous size of the NHS, burdened by complex bureaucracy and hierarchical structures, have to bear much of the responsibility for their failures.

It would be an exercise in futility to enumerate all that is wrong with the health system in the UK, let alone rank or and examine them in minute detail or in isolation. Indeed, there are still many features of our health system that are commendable, albeit under threat.

The problems faced by the NHS fall into three main categories, namely organisation, resources, and user demand.

Borrowing the term from the operational concept of legal chambers, the way HWW Medical Chambers operates will be familiar to doctors, especially those who had worked at a time when general physicians and general surgeons were in abundance.

The presence of consultants who were generalist rather than ‘oligo-specialist’ in their craft allowed for a more seamless referral service. In many ways, their dearth has been more than made up by the growth in numbers of GPs with specialist interests (GPSI). Whilst it is impractical to return to those days, it is nevertheless highly attractive to have teams where all the key specialists are available to provide a smooth and rapid referral service in areas of high clinical need.

A multi-disciplinary team or chamber is therefore the most versatile model, appealing to all non-salaried GPs (GMS and PMS principals), consultants and dentists with part-time NHS contracts or those practitioners who are fully private. Nationally organised, the chamber system run by HWW Medical Chambers would have a large expertise pool, with the benefit of widespread accessibility.

By being small, such units would benefit from high degrees of accountability, responsiveness and therefore efficiency. As self-pay is not an efficient means of accessing the services of such units, pooling in the form of a low-cost heaithcare scheme must be both sizeable and universally available. This being the case, it would achieve for the subscriber a high degree of portability. A national chain of these units, attractive to consumers who would benefit from access to pooled resources, could then derive as its main source of income linkage with such a scheme.

Management of demand in this paradigm then would then become a function of efficient and fast tracking of referrals, with user costs being operative rather than an imperative.

The compelling nature of this system lies in its ideological flexibility. It recognises and respects the freedom of choice and financial autonomy in a democracy. Being driven by clinical need and competition, the quality of services is maintained. Whether medical chambers will supplement or eventually supplant the key elements of the NHS as it is configured today, remains to be seen.

Much of the NHS portfolio of activities is being privatised, and conditions are now at their optimum for the successful operation of HWW Medical Chambers. For healthcare professionals, it represents an opportunity to preserve and strengthen their professional independence which is crucial to the maintenance of the freedom of choice for the public in healthcare provision.

Finally, by an augmentation of the NHS, HWW Medical Chambers would have provided the NHS a unique occasion to expunge the anachronistic practices that hinder it from making significant progress in its quest for modernisation.

Dr T K Khong, MB ChB LLM. Director, HWW Medical Chambers