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But the NHS is already fragmented

The BMA and other professional bodies are against privatisation of the NHS. And yet GPs are themselves private businesses.

If a group of physiotherapists band together to provide an NHS musculoskeletal service, is that privatisation? What about a charity providing a patient service funded by a PCT to provide alcohol misuse services?

I suspect these would not be considered ‘privatisation’ by most people, yet there is little difference between them and a large plc employing GPs, physiotherapists or counsellors to provide the same services.

I also wonder whether plcs will really feature as providers in the future. Many are already pulling out or handing back services because they are unviable. The profit margins are too small.

I also hear of ‘fear of fragmentation of the NHS’ – as if the NHS is not already fragmented. When GPs understandably opted out of providing 24-hour cover and hospital doctors were forced to at least nearly adhere to the Working Time Directive, the NHS became truly fragmented.

Different services working together to create a seamless patient pathway is achievable without a single employer. What it needs is good commissioning, good communication and someone to help the patient navigate.

Patients deserve choice and this choice can actually make people raise their game. We should ensure that our CCGs commission joined-up services using competition where it is needed and stop worrying about who provides the service as long as it is good.

Then again, we should never let a good idea get in the way of ideological dogma.

From Dr Paul Charlson, Brough, East Yorkshire