Views & Reviews Personal View

It’s unethical for general practitioners to be commissioners

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1430 (Published 10 March 2011) Cite this as: BMJ 2011;342:d1430
  1. Mark Sheehan, Oxford BRC ethics fellow and James Martin research fellow, The Ethox Centre, University of Oxford
  1. mark.sheehan{at}ethox.ox.ac.uk

The government wants to liberate the English National Health Service. By this they seem to mean to liberate the NHS from managers. The idea is that managing can be done by those who are already doing another job—general practitioners. It may be that the NHS is currently top-heavy, and it may not be as good as it might be. However, I have several ethical concerns about devolving commissioning responsibility to GPs.

There are two ways to ask how we should allocate NHS resources. Should we fund cheaper, less effective drugs, or better, more expensive ones? Here, the relevant considerations involve population level calculations—evidence of effectiveness, evidence of cost effectiveness, incidence, and projected demand. Alternatively, we might ask whether Mr Jones’s GP should decide to prescribe the drug that is less effective but cheaper, or the better, more expensive drug? Here, features of Mr Jones’s circumstances matter. Does he live alone? Can he cope with a few more headaches? Mr Jones’s GP can answer these questions because he knows him and his situation. The answers to these questions, given on the …

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