You won’t catch me disagreeing about the egregious effects of neoliberalism on health care. And few healthcare practitioners wish for anything other than a recognition of the importance of relationships in the practice of healthcare. So far, so apple pie.

However, there are few hard suggestions here on how we improve things – other than some notions of reconceptualising how we look at the NHS and a faint call of how much better it all was in the past. The inference is that we should go back to that time but the suggestion that it was somehow better in the olden days is contentious. There was much to deplore in healthcare from an earlier era – the dominance of white men, casual overt racism atop systemic discrimination, a paternalistic culture where patients were passive recipients of dubiously evidenced interventions. These are far from resolved but one can’t cherry pick the things one liked from four decades past and casually ignore everything else. There were no 4Cs, no REMIC, and no gigantism but we still had some god-awful healthcare in many regards.

Reasonable suggestions on how to move on from what I agree is a demoralising position are welcome and it’s good to know about the work of organisations challenging these processes. Yes, we need to understand the underlying mechanisms but much of this will take political change on a large scale. I can offer one, small change that would have a large impact. For me, the single biggest immediate intervention, the one we should be advocating is the adoption of longer consultation times to account for complexity and which still allows time for meaningful relationships. At some point, we have to simply jump and do it – there will be short-term pain (and we will have to everything we can to keep the sharp-elbowed at bay) but the long-term gain would be immense.

I am Acting Editor of the BJGP. I am on Twitter @euan_lawson