Is it the end of the ‘national' health service?

Are we facing the greatest postcode prescribing lottery ever seen in the UK? Is the fundamental principle of the National Health Service at risk? Possibly so, if the results of a GP survey are to be believed.

Some four fifths of those of you who responded to our survey on the future of NHS primary care believed that the national GP contract is at risk and that we may see the four countries going their separate ways over general practice.

Nye Bevan’s great idea for the NHS was that every citizen ‘irrespective of means, age, sex or occupation shall have equal opportunity to benefit from the most up-to-date medical and allied services’.

Perhaps he should have also included ‘location’ in that list. We are increasingly seeing variations between the health policies of the UK’s four constituent countries. Payment by Results is changing how hospitals are paid in England; NICE guidance applies to Wales and England, and possibly Northern Ireland before long, but not Scotland; and the so-called ‘national’ care records spine is only for England.

Given this situation,it is not a great leap to imagine contractual and funding decisions splitting further, leaving us with four GMS contracts.

Devolution has great potential to bring government closer to particular populations but it should do so while maintaining standards. In the UK, the three devolved governments have different powers, adding to the likelihood of variations. This situation could have serious implications for patients and doctors.

The UK government has recognised that not all aspects of policy can be devolved — defence, for example, remains a Westminster issue. It should consider maintaining some aspects of the NHS on the same basis, rather than legislating for England and hoping the rest keep up.

Balancing local needs with national standards has always been a difficulty for the NHS but more than ever it is an issue that must be debated to ensure the fundamental principles of the NHS are preserved.

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