Views & Reviews From the Frontline

Flawed ideology drives the NHS reforms

BMJ 2011; 342 doi: (Published 18 May 2011) Cite this as: BMJ 2011;342:d3076

Re:Confused ideology opposes reform

I am not against reform. But reforms must be based on sound
innovation not ideology. Competition is good but medical capitalism is
not. Commissioning is a major change and seems sensible and tested. But I
am very weary of "for profit " companies taking over complex care, for
money always distorts advice towards intervention. Outcome data has almost
become irrelevant for it not what do don't do that is the measure of true

In respect to the self employed status of GPs we are in fact de
facto salaried employees. There was no sale of "good will", we could not
employ other doctors and there are restrictions on opening new premises.
We were pretty hopeless business people but most GPs focussed on their
professional sense of duty. But the New contract changed this, market
forces are at play and has been very devisive in General Practice. Has this
helped patient care and professionalism, it has not. We need to re-establish professional duty at the core of the NHS and all else will

But as for healthy competition - Bring it on !

Competing interests: No competing interests

24 May 2011
DES Spence
general practice