The existence of a publicly funded comprehensive health service feels under threat like never before. In England, there are currently 3.9 million patients waiting for treatment, the most since December 2007. The three million mark used to be considered a watershed, but no longer. In Scotland, nearly one in 10 patients is waiting longer than 12 weeks for an outpatient appointment. As GPs know, these are not just numbers, but millions of patients and their families anxiously awaiting that operation, or a diagnosis; untold pain and mental anguish that is now regarded as the new normal. And the problem is not restricted to outpatients. Pulse has received reports of dangerous delays in ambulance services across the country and GPs in Kent were recently warned not to use ambulance services unless ‘clinically appropriate’ (as if they would). Practices in Hertfordshire were advised to redirect non-urgent appointments to a private provider to take the pressure off a local hospital. And – perhaps even more insidiously – there has been a 6% jump in private referrals after CCGs in one area of England gave GPs a ‘gentle reminder’ to ask patients to consider using private health insurance if they have it, as Pulse revealed last month. These are symptoms of a system struggling to cope. The head of NHS Providers recently warned that there is an ‘unbridgeable gap’ between what the NHS is required to deliver and the money there is to pay for it. And that is putting it politely. NHS leaders have warned the NHS is entering a Narnia-like ‘perpetual winter’ with pressures that used to be the exception now becoming the norm. It may be too early to cast the Prime Minister in the Tilda Swinton role, but she is certainly no Mr Tumnus. We are sliding into a situation where our health service may cease to meet the expectations of the society it serves, and that is dangerous territory. I predict more lurid headlines about the care in NHS hospitals before the year is out, and the battle over the junior doctor contract is not over by any means. Last winter was relatively mild, but a prolonged cold snap this year could tip services over the edge. The public’s trust in its beloved health service is holding, but for how much longer? The sad thing is that the one area that could take the pressure off secondary care is in its own underfunding crisis. Yes, general practice could be the saviour of the NHS if it had been adequately supported over the past few years. But practices are still struggling to recruit and retain. The Capita debacle in England has not helped. As we show in our investigation, resilience funding is not reaching practices. The GPC’s solution is to bat unfunded work back to hospitals, cap patient contacts at 25 a day and siphon off all other urgent care to local ‘hubs’. This could be an effective and relatively speedy solution to the GP workload crisis – and credit is due to Dr Brian Balmer for pioneering it; GPs often tell me they don’t want more money, just less work. But this retraction of the health service will have consequences. Patients will see greater restrictions and those with the means may go elsewhere. We all know there is a wing of the Conservative party that sees a publicly funded NHS as an anachronism. And I worry all this may play right into their hands.