Medicopolitical Digest

NHS is being dismantled, BMA chairman declaresJunior doctors call for new medical schoolChanges made to consultant appointment procedures

BMJ 1996; 312 doi: (Published 20 April 1996) Cite this as: BMJ 1996;312:1043
  1. Linda Beecham

    NHS is being dismantled, BMA chairman declares

    Five years after the NHS reforms all there was to celebrate was “the disintegration of the NHS with its fragmentation into several thousand ‘purchasers’ contracting with some 480 competing local businesses,” the chairman of the BMA council declared last weekend. Speaking at the BMA's Junior Members Forum in Edinburgh Dr Sandy Macara said that this was despite a tripling in management costs in no way matched by a comparable increase in productivity. He did not blame the managers because they were bound to construct or attract deeply flawed contracts based mainly on secondhand historic patterns of demand and supply unrelated to any satisfactory assessment of relative clinical need. The inferences in the changes, he said, were insulting to the profession and to managers.

    The chairman's evidence that the service was being dismantled was that money was not following patients. Patients had no choice but to follow the money until it ran out and no voice to exercise any effective influence. Inequity in secondary care was endemic. “We now have two national lotteries: Virginia Bottomley has taken invaluable experience from the first, the NHS, to the second.” More and more treatment depended on where and whether a contract had been placed. Dr Macara described as the “ultimate fraud” the manipulation of waiting lists ensuring that the more serious cases had to wait longer while less urgent cases received priority.


    The profession continued to emphasise that it was not opposed to change but “the competition for …

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