One thing that any lay person who gets involved with the health system suddenly learns is that the system is complex, unbelievably complex. Successive Governments seem to just add to that complexity – often under the guise of simplification. The trouble is we now end up with a system which essentially operates on a ‘divide and conquer’ basis. Battles between primary care and secondary care, commissioners and providers, public sector v private sector etc. The system starts to dance around itself: success in one part becomes failure for another, for example a service moved into primary care may save money for the commissioners but have a longer term financial impact on the sustainability of the hospital and commissioners find themselves both complaining that staffing levels are too low but the hospital is spending too much. All of this makes sense to the system but not to the patients. I don’t believe I have ever heard someone outside the system break it down into primary and secondary care, they understand some of the differences between a GP and a hospital service but the NHS is one beast to the majority. I think we talk too often of the benefits of primary or secondary care and forget the point. It is truly about the right care, at the right time at the right place. Understanding this does not just mean thrashing this out around a table of professionals but talking to the very patients this affects. To increase my understanding of local landscapes and meet more patients myself, I have started to be involved in my own GP Practice participation group and came across a new dividing line that I couldn’t believe. As we squashed into one of the GP Consultation rooms for the meeting we discussed how we might expand, what events we may wish to hold and how we could engage others. It was then pointed out that the practice do not own the building. This meant that any additional rooms we used we had to hire: hence the squashed room. Who owns the building? Well, the NHS (well NHS Property Services). Another part of the system that needs to feed itself and adds to the ‘internal’ movement of money around the NHS family. (I wonder how much money we spend moving money from NHS organisation to NHS organisation?). I hear a lot of rhetoric around patient voice, I see lots of hard work been undertaken by individuals locally and nationally to turn rhetoric into reality, and then I see barriers. Barriers created by a lack of capacity in parts of the system, by a lack of belief by some still that patient voice is important and now more bureaucratic barriers created by the NHS eating itself rather than putting patients first. There are too many dividing lines in the NHS: perhaps looking at the system from the patient perspective more often may just help rub some of the lines out.