Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Professor Chris Ham writes that “Evidence that competition in healthcare is beneficial is both equivocal and contested. Even where benefits can be delivered, these have to be set against the considerable transaction costs involved in contract negotiations between commissioners and providers and the work of the regulators.”
The British Association of Dermatologists agrees. Prof Ham might also have added to these cautionary considerations, the risk of conflicts of interest, a topic dealt with comprehensively but alarmingly by Gareth Iacobucci a few pages before. This BMJ investigation found that “conflicts of interest are rife on CCG governing bodies, with 426 (36%) of the 1179 GPs in executive positions having a financial interest in a for-profit private provider beyond their own general practice—a provider from which their CCG could potentially commission services.”
It is shocking that Michael Dixon, chairman of the NHS Alliance and interim president of NHS Clinical Commissioners, has called for “more leniency” in handling conflicts of interest, declaring that “the priority is to move services out of hospital and into primary care. The reason this hasn’t happened to date is because of blocks in the system. It’s more important to remove those blocks than be preoccupied with conflicts of interest.” How can a senior official so nonchalantly shrug off financial conflict of interest and the risk of corruption, in justification of a controversial political objective - removing services from hospitals? Are probity and fiduciary duty to be seen as 'blocks in the system'? After North Staffs and the Francis report and the gagging orders scandal, what next?
Re: Regulating the NHS market in England
Professor Chris Ham writes that “Evidence that competition in healthcare is beneficial is both equivocal and contested. Even where benefits can be delivered, these have to be set against the considerable transaction costs involved in contract negotiations between commissioners and providers and the work of the regulators.”
The British Association of Dermatologists agrees. Prof Ham might also have added to these cautionary considerations, the risk of conflicts of interest, a topic dealt with comprehensively but alarmingly by Gareth Iacobucci a few pages before. This BMJ investigation found that “conflicts of interest are rife on CCG governing bodies, with 426 (36%) of the 1179 GPs in executive positions having a financial interest in a for-profit private provider beyond their own general practice—a provider from which their CCG could potentially commission services.”
It is shocking that Michael Dixon, chairman of the NHS Alliance and interim president of NHS Clinical Commissioners, has called for “more leniency” in handling conflicts of interest, declaring that “the priority is to move services out of hospital and into primary care. The reason this hasn’t happened to date is because of blocks in the system. It’s more important to remove those blocks than be preoccupied with conflicts of interest.” How can a senior official so nonchalantly shrug off financial conflict of interest and the risk of corruption, in justification of a controversial political objective - removing services from hospitals? Are probity and fiduciary duty to be seen as 'blocks in the system'? After North Staffs and the Francis report and the gagging orders scandal, what next?
Competing interests: No competing interests