Editorial: The axe will fall upon the NHS, that's for sure

By the time many of you read this it is likely that someone new will be taking up residence in Number 10.

Yet, despite all the main parties putting forward their health manifestos, it is still unclear what a change of government (or not) means for the NHS.

What is clear is that there will be cuts. Where the axe will fall is unknown - no one was willing to spell this out explicitly during the campaign. But, as Dr Chris Lancelot points out below, the NHS will not be spared. RCGP chairman Professor Steve Field believes that, in these financially constrained times, GPs have to work more efficiently and not expect further resources. The DoH and MPs share this view.

PCTs, meanwhile, are already preparing for cuts, with many attempting to force through contract changes for PMS practices as a way to save money.

But, because GPs have received little or, in many cases, no pay increase in recent years, the majority of practices have already taken steps to save money - there is little more they can do to become more efficient.

At the same time as expecting practices to make savings, it is inevitable that policy makers will ask them to take on more work, such as opening for longer, becoming responsible for out-of-hours or, most worrying, taking on real commissioning budgets at a time of financial uncertainty.

MPs need to remember that practices are businesses - they have staff to pay and premises to maintain. If politicians and managers want to maintain or boost services they cannot continue to impose pay freezes.

GPs have patients' best interests at heart, but they also have to protect their business and it is ludicrous to expect them to provide services that could lead them to lose money. Politicians do not expect the legion of private providers they are all so keen on to do this.

The very fact that GP practices are run as businesses is one of the reasons that they are able to provide high quality, cost effective and, in many cases, highly efficient service.

Cutting back funding for general practice is not the way to improve the nation's health - or tackle the soaring national debt.

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