Observations Open Forum

What to cut: readers’ suggestions

BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b1765 (Published 29 April 2009) Cite this as: BMJ 2009;338:b1765

In his “On the Contrary” column three weeks ago (BMJ 2009;338:b1457, doi:10.1136/bmj.b1457) BMJ deputy editor Tony Delamothe invited readers to submit their own suggestions for saving on the NHS budget. Here are edited highlights from some of the responses

Stop quangos and targets

Peter G Davies, GP principal, Keighley Road Surgery, Illingworth, Halifax

A good place to start would be the private finance initiative, practice based commissioning, Payment by Results, Choose and Book, NHS Direct, Modernising Medical Careers, the National Programme for Information Technology, “redisorganisations,” management consultants, and the regulatory quangos that no one understands and that get renamed regularly to disguise their dysfunction. Then how about losing most targets and also the compliance officers needed to police or fudge the figures?

And is revalidation an evidence based treatment for an accurately diagnosed disease?

End the internal market

Leonard Peter, GP, Harrow

The NHS internal market is as useful and cost effective as our banking system. In the early 1990s we created a whole new structure, which split NHS institutions into purchasers and providers. This is delightful for managers because they immediately underwent replication and needed larger numbers and larger salaries as more chief executives were created.

The whole thing …

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