Some time in the next 12 months there will be an election. The choice facing the medical profession seems clear.
It can re-elect a Labour government that has thrown the NHS open to private providers and will have to slash spending. Or it can vote for the Tories, who say they want to keep the NHS open to provide providers but will have to slash spending.
It is into this unpromising political landscape that the BMA has now stepped with its campaign to remind the public of the dangers of 'marketising' the NHS.
It has set out eight principles (see box below), to protect the idea of a publicly funded and provided health service. It has also launched a website, Look After Our NHS, where doctors can register their support for those principles, and share stories of commercialisation.
|BMA aims for NHS|
This, says BMA Council chairman Dr Hamish Meldrum will 'alert (doctors) to the problems of the market and commercialisation, and to how we feel it is taking the NHS away from its true principles'.
The timing seems odd. Despite the apparent hopelessness of the cause politically, there are reasons to think that - in general practice, at least - the private advance has been largely routed.
Companies such as Virgin and Tesco, once predicted to become major players, have backed away from the sector. DoH figures also suggest private providers have won just 21 per cent of the new Darzi centre contracts - half the number won by GPs. (Another 20 per cent of contracts have gone to joint ventures.)
All this is a far cry from the full-scale privatisation feared when the BMA launched its Support Your Surgery campaign last summer.
CBI health adviser Chris Heathcote admits that investors have found the result 'disappointing'. 'But,' he adds, 'that battle's already been fought.'
Now, he says, his members are looking at other opportunities, through initiatives such as World Class Commissioning and integrated care organisations.
So despite the rout in general practice, commercialisation does not look likely to go away. GPC chairman Dr Laurence Buckman says: 'We are concerned that we are reaching a tipping point. The time is coming when the health service as it stands will struggle to survive.'
One reason is the spending drought that is going to hit the NHS in 2011. For much of the past decade health spending has grown by more than 7 per cent a year; after this year's budget, it looks probable that spending will now have to be cut.
Where money is tighter, argues Dr Buckman, it is more important than ever to make sure it is spent on patients rather than shareholders. 'Value for money is important,' he says. 'But if you compete, you're spending money on the process of competition rather than on healthcare.'
There is a second reason why commercialisation may pose a threat to the NHS, more insidious than siphoned-off profits. That is, the sense that NHS organisations have to be run like businesses, competing with their rivals for patients and the funding that comes with them.
The results of this Darwinian approach to the NHS are already beginning to show. Lord Carter of Coles, chairman of the NHS Co-operation and Competition Panel, speaks of 'expansionist' NHS organisations that want a bigger share of the pie.
Meanwhile, the NHS Alliance is fretting over much-loved community services being swallowed up by hungry foundation trusts. As long as managers treat the NHS as a commercial entity, there is the risk that they will sacrifice patient care in their bid to turn a bigger 'profit'.
This is what the BMA wants to set itself against. It wants to circumvent party politics, and explain the dangers of commercialisation to the profession and voters. If it can do that, maybe the next time an election rolls round, the choice will not be so hopeless.
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