In Britain, the published statistics show that although we are still one of the leading countries in clinical and academic medicine, when our patients are seriously ill they would have fared better in most other Western countries.

When outcome is considered, surviving or dying of some dread disease, the league tables demonstrate that we are apparently in the third division and battling it out with Estonia and Slovakia. The statistics are almost certainly skewed as a result of Britain having a more accurate and more comprehensive database than other countries, but even so these errors can’t account for the differences that tables show.

Most of the blame for poor results in relation to the outcome in potentially fatal diseases can be attributed to late diagnosis, coupled with a delay in providing therapy once the diagnosis has been made. The quality of the treatment, once it is delivered, probably compares with other Western countries.

The speed of diagnosis is dependent on the efficiency of primary care. Early diagnosis will be improved only when patients have ready access to their GP and know their doctors so well that they are content, if not happy, to confide in him or her about their sometimes embarrassing, and always tiresome, early symptoms of serious disease. If we could achieve early diagnosis our outcome statistics would then start to compare to those of other developed countries.

Other considerations about general practice are, compared with early diagnosis and outcome, relatively unimportant. The state of the surgery lighting, the colour schemes and even the layout of the surgery are of little concern to those who are dying unnecessarily.

The report of the Birmingham PCT on its future plans for primary care is based on the assumption that although there are honourable exceptions, the present condition of healthcare in many inner-city areas is of poor quality. The standard of general practice in the centre of Birmingham shows unacceptable variations in the medical skill displayed, the ease of access to the doctors and the quality of the supporting staff.

The report suggests that we abandon the present system of general practice and adopt a polyclinic structure with levels. Level 0 would cover self-care and health promotion, level 2 services would essentially be diagnostic centres and level 3 polyclinics or centres would look after those patients needing urgent care for minor injuries and illnesses. Smaller, acute general hospitals would provide care for complex, high-cost medicine and surgery, maternity, paediatric, neonatal, accident and emergency services.

Birmingham’s PCT plan seems to disregard the importance that patients and their doctors give to the doctor-patient relationship. It also hasn’t considered that it is the maintenance of this that has enabled other Western countries to achieve earlier diagnosis and better outcomes. It is striking that the results of the Birmingham analysis show that although partnerships employing five or more doctors offer the State and taxpayer better value for money, presumably because of the better infrastructure both in relation to premises and supporting staff, the most expensive are those practices that have three or four doctors. These practices are unlikely to provide either close family care or the cost-saving derived from having a larger unit.

Amazingly, 57 per cent of patients were satisfied by their doctors’ premises, even though they had been graded as being poor by the authority. Furthermore, there was only a 2 per cent difference in the level of patient satisfaction between those practices that had been graded as having adequate as opposed to good premises.

Patients are far more interested in a doctor who will listen and to whom they can have easy access than they are in the quality of the surgery fittings. General practice at present has problems and weaknesses, but asking Asda, Tesco or Virgin to employ former GPs as “franchise providers” who will be expected to exchange their present status as independently contracted GPs for working very possibly at the self-care and health promotion levels of primary care is not a prospect that will be likely to attract the best students of medicine. Nor will franchise polyclinics do much to improve the outcome in serious diseases, a facility that is at present inadequate in British medicine.

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