GPs who "rip off" patients to be given greater freedom. The end of the NHS as we know it?

I add the following comments to those circulated earlier as "A liberated NHS - Free to levy charges on patients? - Advance briefing on Andrew Lansley's announcement 12 July 2010".

Roughly 10% of NHS GPs in England use revenue sharing 0844 telephone numbers to "rip off" their patients, obtaining a subsidy of their costs in providing NHS services, contrary to the principles of the NHS constitution.

(The term "rip off" was used by the Health Minister replying to an adjournment debate in parliament in 2008.)

Today's announcement in the White Paper "Equity and Excellence: Liberating the NHS" suggests that further freedoms are to be given to GPs to run the NHS locally.

In the forward to the White paper the Prime Minister, Deputy Prime Minister and the Secretary of State for Health acknowledge that the longstanding principles of the NHS have had their day as they acknowledge, "free at the point of use and available to everyone based on need, not ability to pay ...". They however go on to say that the principle of quality outcomes must now replace these, stating "... but we believe that it can be so much better – for both patients and professionals". (That "but" is a big word.)

I would argue that the "Equity" represented by the earlier principles is more important than the "Excellence" which is to replace it, however this determination is in line with the conclusions of Darzi. We have for too long taken the principles of the NHS for granted and failed to recognise that they stand in conflict with those of consumerism.

The BMA GPC encourages its members to believe a meaningless, and false, assurance that the 0844 telephone numbers from which they obtain a subsidy are no more expensive to call than an ordinary number. GPs are clearly not experts in telephone charges and so have no reason to question this lie. One wonders how many more well-constructed scams medics will fall subject to when taking on further commercial responsibilities.

If the BMA expects us to accept that GPs can be entrusted with the principles of the NHS, as they take over the role of PCTs, then we must note its policy that patients should pay for access to NHS services according to the quality of the service provided. That is not to say that politicians or quangos have been seen to be any better at dealing with this situation. Furthermore, patients seeking treatment for a pressing condition cannot be expected to invariably choose the cheapest option in order to preserve the principle of "free at the point of use".

This looks like "goodbye to the NHS we have known" and "hello to paying for higher quality". I will continue to fight to defend a NHS that cannot offer any greater quality of service than we are all prepared to pay for through our taxes.