BMA raises opposition to market driven NHS

BMJ 2009; 338 doi: (Published 17 June 2009) Cite this as: BMJ 2009;338:b2479
  1. Jacqui Wise
  1. 1London

    The BMA has launched a campaign against the continuing commercialisation of the NHS, which it says risks destabilising health services, increases costs, and results in less investment in training.

    The BMA is calling for the NHS to be restored as a public service that works cooperatively for patients, not a market of commercial businesses that compete with each other. It has drawn up eight key principles for the NHS and is urging doctors to sign up to the campaign on its website It also wants doctors to send in examples of how market reforms are affecting them.

    The BMA’s chairman, Hamish Meldrum, said that with the financial recession and a potential change of government soon, the time is right to stimulate debate on the matter. He told the BMJ, “At a time of financial difficulty we should be encouraging all parts of the service to work together and not compete with each other. There is no evidence that competition has driven up quality of care.”

    The BMA says that the cost of the private finance initiative tendering process in the NHS places additional burdens on primary care trusts. Rather than the private sector bearing the risk as was claimed, hospitals themselves are having to pay an additional “risk premium” to ensure that projects run to time and budget.

    The BMA also says that private companies that run independent sector treatment centres have been paid large amounts of taxpayers’ money to deliver large volumes of work, which in many cases have not been carried out. Recent research in the BMJ indicated that the NHS in England may have overpaid the first wave of such centres by as much as £927m (€1097m; $1524m; BMJ 2009;338:b1421). The BMA also points out that more than half (62%) of clinical directors at NHS trusts in England are concerned about the quality of care provided by the independent centres.

    The BMA has also criticised the purchaser-provider split, saying that there is little incentive for commissioners and providers to work together in the planning and delivery of health care. The payment by results scheme, in which hospitals are encouraged to treat more patients while GPs are encouraged to use less secondary care, can also prevent the development of coordinated services that deliver the best care for patients.

    Dr Meldrum said that he would like to see a complete reversal of market driven policies, such as the private finance initiative and independent sector treatment centres, but at the least he would hope to halt further moves towards commercialisation.

    Eight key principles for the NHS

    • Provides high quality, comprehensive health care for all, free at the point of use

    • Is publicly funded through central taxes, publicly provided, and publicly accountable

    • Significantly reduces commercial involvement

    • Uses public money for quality health care, not profits for shareholders

    • Cares for patients through cooperation, not competition

    • Is led by medical professionals working in partnership with patients and the public

    • Seeks value for money but puts the care of patients before financial targets

    • Is fully committed to training future generations of medical professionals


    Cite this as: BMJ 2009;338:b2479

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