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Anus Horribilis

Our GP commissioner at the coalface, Dr Clive Henderson, foresees a populist approach to rationing in 2011

As a cost cutting exercise, sorry I mean efficiency drive, we have been looking at surgical thresholds and which procedures are for the chop. The result of considerable analysis revealed the only absolute veto was anal skin tags. Marvellous, that should sort out the financial deficit. Of course, when I say absolute veto, this would still allow competitive recourse to the ‘exceptional treatment panel'.

How would these anal anemones compete to prove their worth? Length, size, psychosocial factors or patient recorded measures (PROMs ). I can picture the identity parade now. Please adopt the position whilst our judges hold up score cards. Perhaps regional finalists could enter our ‘arse factor' competition. Maybe instead of a meritocracy we simply draw raffles , a true postcode lottery.

No , I am being silly. Let's be innovative and utilise telemedicine, have your mobile phones ready. Let's hope the images are not intercepted by protection agencies.

Whilst we are taking about cuts, how do we feel about GPs becoming NASTY , the rationing provider arm of NICE. All very worrying.

Perhaps we do need democratic legitimacy and let society vote not only on the generics of rationing but on specific individuals too.

What about the ends justifying the means QIPP initiative and having a ‘human interest' TV programme where the public votes on O800 phone numbers to elect the most deserving of their exceptional treatments. That should raise a bob or two.

Yes, I am being ironic but let's hope Simon Cowell doesn't read this.

Dr Henderson is a GP and chair of Goole, Howden and West Wolds locality commissioning group

Dr Clive Henderson