This is a tricky one. This blog has no intention of causing offence to any of my colleagues, but simply to give my opinion. I have written extensively on the subject of athletes as role models, and I don’t believe that we should hold them on a pedestal or put sport stars in that elevated position. However, doctors should be role models and, in my opinion, they need to look ‘healthy.’ Doctors have a responsibility to their patients to exude an aspirational image of health.A close friend of mine was very disturbed about the amount of obese and overweight doctors and the amount of doctors who smoke. The first thing that comes to mind is ‘practice what you preach.’ Would you go to a financial advisor who was bankrupt, or to a plumber who’s sink was leaking? How are patients supposed to take advice from a doctor who doesn’t project the image of a healthy lifestyle?But then again appearances can be deceptive. People come in all shapes and sizes and we know we can’t make snap judgments about overweight physicians; they may practice good habits while many seemingly fit physicians may have very bad habits. So, do we rush to judgement? Dr Regina Benjamin, former US Surgeon General, once said that, ‘what makes a physician credible is whether they practice what they preach and the lifestyle recommendations they propose.’ I can’t help but agree with this sentiment – but judging physicians solely on their outward appearance could be detrimental.Now the NHS has spoken up on this issue. A recent article in the Telegraph states that overweight doctors and nurses have been told to slim down by the NHS Chief. There are 700,000 NHS staff classed as overweight or obese and they must shed these excessive pounds in order to set a good example to patients according to Simon Stevens, NHS England Chief Executive. My question is: how are they going to implement this? I can understand the NHS’ urgency to address this issue as it emerged recently that obesity and its related health problems, may now account for a third of the 110 billion NHS budget. But is it a feasible task?Finally, there is another side to the argument. Physicians are still people, and they can be just as imperfect as their patients. Expecting a doctor to always follow recommendations that he or she gives their patients, whilst intuitively logical to expect, is probably not realistic in real-life situations. This is a very interesting debate. I look forward to see whether Stevens’ order will actually change the aesthetics of the NHS. I am a real fan of the NHS. It does the best it can with the available resources, but there’s a demand for more funding and significant restructuring. It seems quite obvious that we need a change in the way the NHS is funded. When the NHS began there were no MRI scans, people didn’t live as long as they do now; drugs and procedures were not expensive as expensive as they are now. Our knowledge of medicine has evolved, now NHS must evolve as well.An article in the May BMJ highlighted that GPs had voted against charging patients for their services. I fully appreciate that the NHS was built as a free service, but you can’t have it both ways. If you want improvements, you have to pay the price – there’s no way around that. The NHS cannot continue in the way that it’s going, but Governments are scared of change. Any suggestions of part payment for the NHS could lead to a catastrophic result in the polls. In many ways the NHS is like Social Security in the United States… no Government has the courage to try to change it.What I would suggest is a graduated co-payment system. Why should a billionaire have free health care? Why can’t that billionaire contribute a little bit towards the NHS? We should provide free health care for those who can’t afford it and have a graduated co-pay system for people who can afford to contribute more. Surely this would be a sensible solution.I believe that General Practice is unsustainable in its current format and has suffered years of under-funding causing immense and irrevocable damage. There is a recruiting and retention problem of GPs; especially with the increasing workloads, it is becoming unmanageable and unsustainable. These sentiments were presented in a motion by Helen McKeown from Wiltshire Local Medical Committee, she goes on to say that the time has come to lead a profession that puts a true price on the value of General Practice. She further says that if the cornerstone of the NHS is to remain firm then it’s vital that money is put in to General Practice. A fee for some services for wealthier individuals would sustain the NHS while they build up a reliable workforce and make General Practice more attractive than retirement and General Practice abroad. Finally, she goes on to say that we need an honest Government who is willing to say who and what will be completely covered by GPs as an NHS service.I agree with McKeown when she emphasised that a system of charging patients should not profit the private sector but would directly support General Practice. However, there are GPs, for example Laurence Buckman, a member of the BMAs General Practice Committee, who disagree and states: “You then get survival of the richest and not treatment for the sickest”. Personally I am not sure about that.It’s clear that this debate will continue and the current way that the NHS, especially General Practice, is funded has to be reformed. The NHS is a great concept, a great idea, but unsustainable in its current format. We need our leaders to step up and make the necessary changes.