Malcolm Chisholm became an isolated and besieged figure in his last days as Scotland’s health minister. Nevertheless, one of his last decisions in that job, commissioning Professor David Kerr to produce a blueprint for the future of the Scottish National Health Service, may prove fruitful. The Kerr report was unveiled last week and it may well prove to be the medicine desperately needed by the health service, which has developed a habit of haemorrhaging cash.

Kerr has come up with some sensible ideas, and his approach has been refreshing: asking us — that is to say, ordinary citizens, prospective patients — what we look for in the service.

Reading the report’s conclusions, I was reminded that 17 years ago the David Hume Institute held a conference on the financing of the health service. Discussion ranged far and wide and I was asked by Professor Sir Alan Peacock, then the institute’s executive director, to “write up my reactions to the day’s proceedings”. My task was, as Peacock put it, to represent “that inveterate absentee at conferences, the common man, rich or poor, in the waiting room or the ward bed”.

In my summings-up I remarked that “much of the discussion about the NHS centres on hospitals, but perhaps the service’s worst fault is its misuse of what should be its most important members, the general practitioners”.

This is even more true today than it was in 1988. It is one of the merits of Kerr’s report that his proposals will, if acted upon, restore to GPs some of the responsibilities that have been taken from them. He calls for an extended role for GPs and other health professionals. The logical way of providing this would be through a programme of building new cottage hospitals (and reopening old ones) to be run by GPs.

People want an efficient NHS, but defining efficiency is rather more difficult. Concentrating hospital services in large general hospitals may be efficient from the point of view of those providing the services, but those in receipt of the service may think differently.

Obviously those in need of specialist operations will have to travel to specialist hospitals for treatment. But in most cases people want to be treated in a local hospital where family and friends are close at hand. They will be pleased, therefore, to find Kerr saying that “the overwhelming majority of people’s health needs can and should be met locally”.

The proposal that emergency healthcare can be dealt with in local community casualty units staffed by GPs, nurse practitioners and paramedics also makes sense. Kerr recommends that these should be able to provide “the vast majority of hospital-based unscheduled care”.

This will be expensive, both to set up and to run, but few can dissent from Kerr’s conclusion: “Given the extraordinary pressures that we face it should be obvious that the status quo cannot be an option.” It should also, one might add, be obvious, that the huge increase in spending on health which the NHS has received in the past 10 to 12 years is unlikely to continue.

This is one reason why we cannot continue to employ GPs as we now do, forcing them to spend far too much time filling in forms and meeting arbitrary targets imposed by the central authority. Allowing them to decide for themselves how best to run their practices and what services they should provide is an essential reform.

One reason for the increasing demands being placed on the health service is that we have more and more old people, many suffering what are called chronic conditions. They are often people whose condition requires treatment but is not going to be cured. Kerr recommends “more care in the community to avoid bed-blocking”. He might have been wiser to have found another descriptive term, because for many “care in the community” has come to mean an absence of care.

What I think he intends is that as far as possible such patients should be treated at home — which, to be effective, would require the recruitment and training of many more nurses and paramedics, working under the supervision of a GP. It is also desirable that provision should be made for such patients to be able to find temporary accommodation in local (cottage) hospitals, to enable family members who look after them to get a break. This, too, will not be cheap.

Kerr’s report points the way towards a locally based and more responsive health service. It is good that it has received the backing of the executive and of Andy Kerr, the health minister. It will not transform the health service overnight. Indeed, the time scale envisaged is 20 years. But it points us in the right direction.

However, Dr Dean Marshall, deputy chairman of the British Medical Association’s Scottish GPs committee, sounds a note of warning: “We have had a variety of these reviews and reports and the problem is always implementation.”

Quite so: the best way of pushing on with the implementation is to trust the doctors and keep the bureaucrats out of the picture. On past performance, the opposite is more likely.

Times Recommends

• UK regional accents thrive against the odds
• ‘Scarecrow’ wind farms put rare birds to flight
• What an anti-climax: G-spot is a myth