General practitioners should be allowed some discretion and humane flexibility

Doctors are familiar with ethical dilemmas. The tension of irreconcilable imperatives is a permanent feature of most of our working lives. For example, our professional ethics teach us to treat patients according to need, but in the context of a publicly funded service, resources will always be insufficient. The introduction of identity cards, dovetailing with plans to change the regulations governing eligibility for free NHS primary care, are nevertheless likely to intensify these dilemmas for general practitioners and some hospital doctors.1 2

Eligibility to free health care is quite properly a political question, to be decided by due democratic process. Crudely speaking, the NHS is a giant national risk pool—an insurance policy—and those who have not contributed, to the extent of their means and ability, should not draw on its reserves. We are properly indignant at those affluent foreigners who visit the United Kingdom because they do not wish to claim on their own private health insurance. NHS trusts also have a legal obligation to ensure that only those eligible for free care receive it. Yet the current proposals seem likely …