Intended for healthcare professionals

Views & Reviews Personal View

GPs should have to take financial responsibility

BMJ 2010; 341 doi: (Published 14 October 2010) Cite this as: BMJ 2010;341:c5613
  1. Danny Ruta, joint director of public health, Lewisham Primary Care Trust and Lewisham Borough Council, London
  1. d.ruta{at}

What is the real aim of this white paper, Equity and Excellence: Liberating the NHS, this mother of all policy interventions? For me its ultimate purpose is almost surreptitiously inserted in just one terse bullet point on page 45, perhaps in the hope that it will pass unnoticed all the way to the statute books. It states, “GP consortia will align clinical decisions in general practice with the financial consequences of those decisions.” These reforms will fail unless GPs are legally obliged to take financial responsibility for practice budgets.

There it is: to force doctors, once and for all, to consider the opportunity costs of their day to day clinical decisions. I believe that this has been the unstated aim of every major health policy initiative since the mid-1970s. Why? Because only by getting doctors to acknowledge that NHS resources are scarce, that every clinical decision has an opportunity cost, and that they should take financial responsibility …

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