Intended for healthcare professionals

Rapid response to:


Reorganisation of the NHS in England

BMJ 2010; 341 doi: (Published 16 July 2010) Cite this as: BMJ 2010;341:c3843

Rapid Response:

There are more effective ways of saving money than reorganisation of the NHS again

I agree with Kieran Walshe that the proposed reorganisation of the
NHS ought to be subjected to careful scrutiny and debate, rather than be
forced through Parliament in the cavalier ways that successive governments
have introduced previous expensive and disruptive reorganisations. I
believe that both the profession and the government would do better to re-
examine one of the basic principles in the way we currently manage our
health service.

Over the last 40 or 50 years we have gradually ensured that not only
do we finance health services for individuals who fall ill, but
increasingly, we spend millions of pounds on paying for expensive
medication that is prescribed freely to many to benefit few. I am
referring to the large numbers of patients who are prescribed treatment to
reduce hypertension and lipidaemia in an attempt to reduce cardiovascular
disease, and the large numbers of people who are given influenza
immunisation every year in order to try to prevent severe respiratory
I am not suggesting that attempting to prevent disease is wrong - far from
it. I have spent most of my professional life identifying people who are
at risk of such diseases and persuading them to modify risk factors and,
if necessary, to take appropriate medication. In England, every man,
woman and child currently contributes at least £30 every year to ensure
that the NHS can provide this medication.
I believe that as we look at ways of reducing government expenditure on
health, we could do well to remove this burden of expenditure on
'Preventive Medication' from the public purse, using the costs that are
saved to ensure that individuals continue to receive high quality medical
and surgical care. If the public are informed that we currently treat
about 50 patients with cardiovascular risk factors to prevent one of them
developing disease, I think they will appreciate the need to make this
significant change, rather than reduce the medical care that is provided
for individuals. As doctors discuss these issues with people with
cardiovascular risk factors, I think it is likely that they will
appreciate the reasons for the change and will accept the need to pay for
the medication themselves. It is likely that they will then value such
medication and take it appropriately. They will also ensure that the least
expensive medication is prescribed.

Prevention of cardiovascular illness has achieved much success over
the years and it is important to continue with this, but not at the
expense of treating all those individuals who have problems requiring

Competing interests:
None declared

Competing interests: No competing interests

19 July 2010
Michael J Whitfield
retired GP
Bristol BS8 2EP