One of the greatest source of disquiets about the NHS is not that there are long hospital waiting lists - although no-one is overly chuffed by that - but that people cannot get to see their GP.

The idea being put around by politicians is that there is a shortage of GPs in the UK.

The claim is being made that this requires that we train assistant practitioners - who are not, by a very long way, comprehensively medically trained - to take the place of the GPs we cannot get.

But this is not true. As the GP Online news service from the British Medical Association reported last month:

The BMA has warned that thousands of GPs are currently 'underemployed' because practices can't afford to hire them - and GPonline has reported in recent weeks on locum GPs turning to foodbanks and one GP working as an Uber driver because they were unable to find a job in general practice.

This report is not made in isolation. This letter in the GP newspaper - Pulse - provides personal evidence of the fact that this significant level of unemployment amongst GPs is now happening.

So what is going on? Three things are, I think.

First of all, the government is deliberately making the NHS crisis worse. The goal, presumably, is to encourage private medicine as an alternative.

Secondly, it is also doing that to promote the 'cheap' option of assistant practitioners - even though horror stories resulting from their lack of broadly based knowledge because they are only trained in specific fields (at best) when medicine is necessarily a holistic subject, are now becoming commonplace. The aim is to break the role of the doctor.

Third, the Treasury has said we can no longer afford to provide people with the medical care that we need, even though we know that the trained people who could provide it are available and the multiplier effect of that spending is considerable, all because they want to do nothing more than balance their spreadsheets, whatever the cost to real people might be.

And what is Labour saying about this? Nothing at all, as far as I can see.

So why isn't Labour saying they will find a job for all trained GPs who want to work? That's all down to Rachel Reeves' iron-clad fiscal rules, I am sure. She would much rather people die than spend what is needed to help them.

And that might be one of the tests for a new Labour government. Will they end GP unemployment, or would they rather people suffer?

I took part in a discussion yesterday on what might happen to left of centre politics if Labour does, as expected, win this year‘s general election. The assumption was that it would do so on the basis of a profoundly right wing platform, which it appears that it has every intention of delivering when in office. Firm conclusions were not reached, but I thought it worthwhile sharing some of those thoughts that I presented.

We will, of course, know more about the likelihood of Labour having a substantial majority in the Commons after this week’s local council election in some parts of the UK. If, as seems likely, a very large majority is in the offing, my suggestion was that a number of problems will have to be faced by Labour, almost immediately.

The first is that once any post-election euphoria is over and it becomes apparent that Labour has not only no plan, but also no intention, of changing the Tory approach to government, with austerity remaining a likehood, then significant buyers’ remorse will rapidly set in amongst the population in general. This will be fuelled by a mainstream media that will be all two willing to criticise every move that Labour makes. Keir Starmer’s honeymoon period with the British public might be very short.

If, at the same time, Labour has a substantial majority (by which I mean anything on the scale of 80 or more, with that figure being deliberately picked because it was the level that Boris Johnson achieved in 2019 that has not delivered the Conservatives a basis for continuing power) then Starmer will face a very particular problem. This will come from a multitude of existing and new back benchers who are not ultra-loyalist to him, but who nonetheless think that they might have a good prospect of retaining their seats in the future, and who will, therefore, have the confidence to challenge his leadership within the constraints of the party within Parliament. They will,of course, know that nothing they do will prevent him from getting his way, but they will also simultaneously be aware that they can present alternative thinking with relative impunity in this situation. In other words, Starmer is likely to have a considerable problem with party discipline if his majority is too large.

Thirdly, political instability in Scotland will not be the blessing that many think it might be for Labour. Governing Wales has not proved easy for Labour, and they have relied upon coalition agreements there. The same might be true in Scotland if the SNP leaves government. The potential for embarrassment that this might create - especially if Labour has, as a result, to govern with the support of the Tories - might be very significant, especially when the Labour front bench team in Scotland is particularly uninspiring.

Fourthly, there will always be what Harold McMillan was reputed to have described as “events“, which by definition have the capacity to undermine the best laid plans of any politician. The particular risk is that these events might require additional spending that will prove that Rachael Reeves supposed commitment to ironclad fiscal rules is skin deep, and probably non-existent. The whole promise for government that Labour has made might be shattered in that case.

Put these factors together and although right now the realistic prospect for getting almost any of the ideas that I am currently promoting into the Labour manifesto appears decidedly limited, in reality the demand for policy alternatives, with explanations being available on the way in which they might be funded, could be very high quite soon after the general election happens.

I am old enough to be aware the politics is not a short-term game. This year’s general election does not offer me any good reasons for significant hope. But, I seriously expect that change will follow thereafter, because I cannot imagine any way in which Starmer and Reeves can succeed with the policy proposals that they have made. In that case policy options for those anywhere on the left of the political spectrum must be available.

I am living in hope.

Rishi Sunak was interviewed by Trevor Phillips on Sky News this morning. He was petulant, pedantic, defensive of his record and simultaneously aggressive towards Phillips, whilst also being inappropriate and evasive. Apart from that, the interview went well.

I do, however, wish to ignore all those points and pick up an issue which he did not, of course highlight. Nor did Phillips.

Sunak’s claim was that we have to increase defence spending in the UK as part of our programme of defending our borders. It’s all very Trumpian.

Simultaneously, he was adamant that we have to ‘stop the boats’, and that those words should be interpreted in accordance with their plain meaning. In other words, he was saying that there should be no more of what he describes as illegal immigration, even though the vast majority of people crossing the Channel do so legally, meaning he entirely misdescribes the problem.

In all this Sunak downgrades the significance of any measures to tackle climate change. He has no interest in doing that. Trump does not believe climate change is real, so nor can Rishi. In doing so he does, however, miss the glaringly obvious point, which is that the biggest threat to our borders comes from climate change.

We face the threat of serious inundation of large parts of the country from floodwater, whilst anyone who pretends that climate change will not create refugees in record numbers is straightforwardly in denial of a glaringly obvious truth that is staring us in the face.

That is what Sunak is now doing.

Unfortunately, it seems to be what Labour is doing as well.

We have a particular problem there seem to be no grown-up thinkers in UK politics right now who can look at the underlying long-term causes of the issues that we face and base policy upon addressing those issues so that we might anticipate and even prevent problems arising. They prefer short-term posturing instead.

It would really help if we could have politicians who could think beyond their need for instant gratification right now, but Labour and the Tories (at least) do not seem capable of providing them.

I posted this video on YouTube this morning. It is a particularly current topic. Railways are an issue in which I have particular interest. I first read a textbook on the economics of the nationalised rail industry in 1975. I still have it somewhere. And I have never changed my opinion about the importance of state control of our railways. In that case Labour’s plans appeal to me, but I have reservations. Watch on….

The transcript is:

Labour's plans for renationalising our railways make sense as far as they go, but they don't go far enough.

Let's talk about the basics of this. The basic fact is that railways should never have been privatised. As long ago as a century ago, in 1923, Winston Churchill and others realised that the idea that private companies could run railways was really rather bizarre because that imposed enormous cost and did not create competition, simply because there's rarely going to be more than one set of tracks between two places in the country. Sometimes, but rarely.

And so it made sense to bring companies under common control. Now in 1923, they backed off nationalisation and instead went for something called ‘the grouping’. There were four large companies in the UK. That didn't really work. Frankly, it didn't produce the benefits they wanted. So, in 1948 we got British Railways.

That worked until the era of the 1970s when a lack of finances, or what the Labour Party and the Tories of that period thought were a lack of finances, undermined the delivery of a combined new rail network, because of underinvestment in the main. And then we limped towards privatisation, which was meant to bring in vast amounts of new private capital to transform our railways.

Let me give you some numbers. In the last year, 2022-23 - that's the last one we've got data for - we know that the government subsidised the UK railway system by nearly £20 billion in a year. Now that was much higher than before Covid, but that's the total cost. The total amount of private capital that was brought in by the railway operating companies was just 4 percent of that total.

So let's not pretend we have an effective privatisation model of railways right now. We haven't. We've got a nationalised system of railways already, and we need that system because it will deliver efficiencies.

I bet you, if you travel regularly on railways like I do, you have suffered the problem of arriving in a station to see the connection that you were hoping to make disappearing because it's run by another train operating company than the one that you came in on and they are not required to coordinate with each other.

If we have an integrated railway, which is what I hope Labour will try to deliver, then such things shouldn't happen. The customer, and not the profits of the operating company, should come first. So, if Labour do that, we should get benefit.

And they will be able to fund benefit, because nationalised railways are cheaper to run.

Why? Because there's vastly less accounting to do. Nobody has to agree who's responsible for a train running late. It doesn't matter whether it's the operator, RailTrack, or somebody else. It's late, and the compensation is due. Hundreds of people have to work that out at present.

There's also no problem with ticketing. If I move from where I am in East Anglia to, say, Lancashire, I'll go through several railway operating companies to get the journey completed. They have to agree how they split the ticket. Now you can say there's a formula to do that, but setting the formula still takes time.

And the point is, all those costs will be saved. Everything should work better as a nationalised railway.

But one thing - and this is where Labour's plans don't go far enough - Labour needs to have its own train leasing company, because right now all the trains run on all the British railways are leased by three companies to the railway operating companies, and those leasing companies make a fortune.

They make around 25 percent of what they charge to the railway companies a year - probably a billion in profit. That's excessive, unnecessary, inappropriate, call it what you will. Labour has to invest in its own trains for the future.

The average train in the UK is 16 years old. We now need new investment. We need to maintain the ability to make trains in the UK. We need to do so persistently. Labour has to also fund it with government because that will be cheaper than the option of using private finance. We know that. Labour has to genuinely believe in nationalisation.

Its claim that it's not interested in dogma when it comes to this issue is ridiculous. It should be interested in economics and the economics of this demand a nationalised railway service.

Labour, stop prevaricating. Deliver what this country needs. And that is a nationalised railway service.