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Hobson's choice

Tony Blair has told Patricia Hewitt that patient choice is to be her top priority in the coming year.

Ahead of clearing deficits, ahead of improving access and ahead of public health promotion.

Choice, he wrote in a letter to the Health Secretary (page 10), 'drives improvement and value for money'.

It also 'empowers patients', he said.

Now contrast this position with what the Department of Health's lawyer, Javan Herberg, told the High Court last week (front page).

At the judicial review into the takeover of two Derbyshire practices by US health care giant UnitedHealth, Mr Herberg said PCTs should not have to consult patients where firms take over an existing surgery. If they had to, he argued, it could derail plans to bring in more alternative providers.

Choose what you're told

So there we have it. Choice is the top priority. Unless, of course, it gets in the way of the real priority of allowing corporate giants to pick off parts of primary care.

As for empowering patients, that's fine unless patients choose local GPs who know and care about their area. In which case such power is too dangerous and must be stripped.

This rhetoric/reality gap applies also to practice-based commissioning (page 2).

The rhetoric is 'give GPs power over budgets'. The reality is 'oblige GPs to do what we want, and if it doesn't work we can blame them'.

The truth is that, whatever it says to the contrary, the Government cannot, and will not, let go.

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