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Taking the national out of the NHS

It could be the week health secretary Andrew Lansley finally lost the profession.

First David Cameron opened up his box of tricks and revealed it contained a host of other ways of privatising Britain's public services than merely GPs' bogey policy of ‘any willing provider'.

And then, in a couple of follow-up sucker punches, the NHS Co-operation and Competition Panel found the health service was unfairly excluding private companies from running services, and the new interim head of Monitor said he expected the NHS to be deregulated along similar lines to the gas and electricity industries. All of a sudden, the mutterings that the NHS reforms were a front for privatisation became a roar, and scepticism among many GPs hardened to raw hostility.

It is becoming clear that the possibilities Mr Lansley envisages for the private sector go far beyond what Labour had countenanced, when it had an any willing provider policy until shortly before the last general election, and beyond too what the Liberal Democrats had imagined when including the policy in their manifesto.

Both those parties wanted NHS providers to be thrust into competition with the private sector whenever a new service was set up. But the coalition Government looks set to go far beyond that, by arguing that private companies should be able to challenge for the right to run any existing public service if they can show they can offer better value for money. Nigel Edwards, acting chief executive of the NHS Confederation, called the plan ‘a game changer' and speculated that private companies could challenge GPs for the right to take on their practice contracts.

As the threat from the private sector crystallises, so do GPs' views about the NHS reforms. A Pulse survey this week reveals just 14% support the any willing provider policy. Mr Lansley, a man who has set out his stall as an unashamed enthusiast for general practice, has the ‘great confidence' of only 7% of GPs. A damning 56% declare themselves to have ‘no confidence' in him.

The shame, from the Government's point of view, is that it didn't need to be this way. Pulse's poll in the immediate aftermath of the NHS white paper found a cautious, nervous thrill of excitement among GPs.

Still, even now, 46% support ‘the principle of GPs holding budgets and commissioning services', which, lest we forget, was a reform too far for the last government.

GPs were there to be led, but like some Pied Piper in reverse, the more the health secretary has played his tune the more the profession has been pushed into opposition. It doesn't help that so many of the melodies seem familiar from the old-style Conservative playbook of privatisation.

As the BMA's Special Representative Meeting approaches, now is the time for GPs to make a choice. Can they support GP commissioning, if it means being players in a freeform, neo-liberal NHS market? GPs should probably accept that a degree of competition and private involvement is inevitable, perhaps even helpful. But what Mr Lansley has in mind would take the national out of the NHS.