Self-service

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Saul Miller

‘Sorry.’

I nod my head as I concede defeat. A woman in Lycra has beaten me. I’m not the only one in a rush, clearly.

As she turns to start unloading, we both realise I need to take a step or two back, to give her space.

‘Sorry.’ I repeat, retreating.

It would not feel so bad if she had beaten me with 6 items or less, but this is a queue for baskets and hers is fully loaded.

Frustration rises like a spring tide. I cast my eyes around again. It is opening time on Sunday morning and I was expecting no delay.

Then I spot the self-service checkouts.

I hesitate, caught between the certain mild inconvenience here and the uncharted territory over there. Her basket sways me. That and the sight of an assistant supervising the do-it-yourself checkouts.

‘Morning!’ I greet her warmly. I might need her onside.

Several others are busily serving themselves but there are plenty of these checkouts free: the till operators in aisles 1 to 15 must sense their uncertain future.

I place the basket in its allotted place and press the cheery screen to start. A recorded female voice instructs me firmly but encouragingly. Even so, I am soon stuck.

‘You have to put your bag in here to load it’, the smiling assistant tells me, gently guiding me towards correct behaviour.

The till seems satisfied and we carry on. By the time I leave the place though, the patient assistant has needed to correct my actions several times more. Any gain I might have made over the position in the queue I gave up has been lost. Still, I do not mind: I will be quicker next time. Besides, I am impressed with the way they have deconstructed the checkout process so they could halve the number of people involved in each sale, almost.

The small shops in town already struggle to compete on price. And no one values expertise from shopkeepers now. Already, 0.1% of businesses in Britain have a greater turnover than the rest put together.1 With self-service meaning fewer staff and further reductions in wage costs, big supermarkets like this one will further increase their advantage.

This is where general practice is. We are caught in a closing vice, ever bigger hospital trusts on one side and big business — that same 0.1% — being helped into public service provision by a conniving government on the other.2 The problems for every other small business are the problems we face, especially the power of the competition to tilt the tables in their own favour, by whatever means. Federation, a proposed solution, is an if-you-can’t-beat-‘em-join-‘em strategy to resist that vice. Without government support, there seem no stay-small alternatives.

And whatever the problems with the nationwide 111 helpline,3–5 the drive to deconstruct medicine, to unbundle it into its constituent algorithms, will continue. Corner shops thrive on their relationships with their customers but for big supermarkets loyalty is just another commodity that can be dissected, dehumanised, priced.

Personal continuity weakens but the self-service consultation is still some way off. Perhaps it will be a good solution for Sundays?

• © British Journal of General Practice 2014