Speaking about the BMA's submission to the DoH's personal health budget consultation, BMA chairman Dr Hamish Meldrum said: ‘We believe in choice and flexibility for patients but these plans are worrying for a range of reasons.

‘Apart from the practical difficulties and added bureaucracy involved, direct payments would take us even further towards a model where healthcare is a commodity to be bought and sold rather than something to which people are entitled. These proposals potentially undermine the principle of equal access on which the NHS is based.'

BMA concerns include:

• a new layer of bureaucracy and administrative burden on PCTs,
• production of an inequitable system that funds services or treatments for patients who hold a personal budget but not for those who do not,
• need for safeguards to prevent exploitation if budget held by third party,
• potential for PCTs to refuse or ration further care to patients who had spent their whole budgets,
• fear patients will save funds ‘for a rainy day' rather than spending what they need on their care, and,
• reinforcement of the idea of healthcare as a commodity.