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Andy Jones: Milking the NHS for votes

What is life like for a public service in the political firing line?

What is life like for a public service in the political firing line?

Two mice fell into a vat of cream. The first gave up and drowned. The second scrabbled so hard the cream turned to butter and the mouse climbed out.

What is life like for a public service in the political firing line? We are about to find out during the long run-up to the next election. For the foreseeable future health is going to be the number one topic for both main parties. And the buzz-word is going to be reform, just as choice was the buzz-word in the recent past. Primary care and the activities of GPs are going to be analysed and considered with renewed vigour by politicians and the media.

David Cameron has just pitched his tent slap-bang on top of Tony Blair in the centre ground of the political spectrum. Public sector reform of the NHS, and in particular reform of primary care, is in both their sights. The Conservatives have turned their backs on tax breaks for health insurance and for co-payments.

They want to present themselves as the real radicals, attempting to realise the promises New Labour have failed to deliver.Health care free at the point of need is the mantra of both parties. Labour has tried centralised bureaucracy, health delivery plans and extensive target setting as a method of running things. There is widespread agreement that these initiatives have fallen short and that money has been wasted. So David Cameron is putting his faith in enterprise and innovation.

The forthcoming discussions will be based on whether Labour's current limit of 15 per cent of health care being provided by private companies remains. This is controversial to the unions and backbenches, and preferential contracts have raised a great may eyebrows and should be widely pilloried.

Currently 5 to 6 per cent of work is done outside the NHS using taxpayers' money: Andrew Lansley, the shadow Health Secretary, has proposed that this goes much further.So where does this leave us? The answer is practice-based commissioning.

A taxpayer-funded, free-at-the-point-of-need health system is highly desirable, but after more than half a century needs to be reformed and made more efficient. Put simply, health care is about to become a business with conflicting interests at stake.

As GPs we are going to face those conflicts. On the one hand we will be acting as advocates for our patients. On the other we will have a very high degree of responsibility for how NHS money is spent.Some within the profession say we will have too much power. Others baulk at the idea of GPs having to make tough financial decisions, in effect rationing health care. Would you want to represent your commissioning body and say No to a woman needing Herceptin, or stop a heart procedure offered on the NHS to the PM?

It also pays to remember that the current NHS spending cycle ends in 2008. Who knows what future budgets will be. Who knows how the roles of GPs will develop. But the moral of the tale is clear. We must fight for what we believe is our right and proper role as GPs. Only by doing this will we get an appropriate resolution to health care problems.

Dr Andy Jones is a GP in Stamford, Lincolnshire

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