Labour's big plans for our GPs make me feel sick

The world's most famous faded film star, Norma Desmond, used to protest: "I am big - it's just the pictures that got small." New Labour's problem is perhaps the opposite: as its political authority and poll ratings shrink, its instruments of policy become ever larger and more grandiose.

The Government's latest addition to "Titan" jails, super-regulators, and insanely ambitious computer databases is the "polyclinic" - a merger of seven or eight GP surgeries to create 25-doctor practices where a patient might never see the same medic twice.

There are some real potential advantages in this: a greater chance, perhaps, that you can get an appointment when you want one; broader expertise; a wider range of treatment on hand without having to go into hospital.

But it strikes me as suffering a more fundamental disadvantage: that it goes against human nature. Relationships are the key to our wellbeing. One of the reasons we still feel so discontented with our public services - despite objective improvements in many - is the systematic destruction of personal relationships within them.

We are better served if we know our local public servants, and they serve us better if they know us. Even in London, many communities are quite stable enough to be able to form relationships with their local police officers, postmen, railway ticket clerks, council workers, if only all these officials were not rotated around by their masters like 78rpm records.

A few public services are starting to recognise the destruction, and rebuild. Centralised policing has yielded a little to safer neighbourhood teams, though their personnel still move around too much. The police may have finally realised it's better if the same officers are assigned to the same area all the time, building up relationships, knowledge and trust.

So why, in the NHS, are we destroying one of the few reasonably solid redoubts of personalised service: the link between a patient and their GP? Even though the doctor-patient relationship may matter little to most of us who seldom see our doctors, it is the most important pillar of the NHS for many others.

As one GP told the BBC: "I have been in practice for nearly 25 years. I have looked after patients from when they were babies to when they've grown up, and they've brought their babies to me. I know my patients." That, I think, may be as valuable therapeutically as any medical advance.

Ministers may talk of personalised services. But nearly always, New Labour's preference is for the big and the central over the local and the personal - the mega-hospitals an hour's bus ride away from anywhere, the huge schools, the out-of-town hypermarket instead of the closeddown local post office. They may look nice and shiny on TV, but they are the very opposite of the things that make "sustainable communities".

Sustainable communities are made up of people who know each other and look out for each other. Call-centres, standardised treatment plans and a computer database of patient records can never make up for human relationships. And that is why GP practices, and all other units of public service, should be smaller, not bigger.