Liam Farrell: Our duty will always be to the individual patient

Some years ago the Northern Ireland orthopaedic service had a whizz of an idea.

Instead of a waiting list, all GP practices were given 'slots', into which we would grade patients according to their urgency.

It was a stroke, a brilliant demonstration of dissimulation; at one sleight of hand, waiting lists appeared to have been abolished completely.

Angry patients could no longer vent their frustration at the hospital's incompetence, as the hospitals could hold up their hands and say, hey, it's not our problem, you should ask the guy who is in charge of the slots, go and talk to him and don't take no for an answer, look there he is now, get after him, quick, here's his address if he gets away, why not organise a lynch mob, here's a rope we happen to have handy, and some tar and feathers.

Rationing has never been a GP's problem; if we feel a patient needs a certain treatment, we say it.

We are, unabashedly, the patient's advocate.

This is not to say we don't understand the wider picture, that resources are scarce and getting scarcer and that with an ageing population and medical technology constantly advancing, costs are only going to rocket; we understand that we must act responsibly, that we should prescribe thoughtfully and refer judiciously.

But our ultimate duty, and the duty that defines our role, is to our individual patient. All this may be about to change, thanks to that lovely new term, the consortium (how do they keep coming up with this stuff?), which really is just another word for getting GPs to do the dirty work. GPs will now not only be responsible for clinical decisions but also for the financial consequences of those decisions.

Priority setting and resource allocation (sound like fun, don't they) will now be our responsibility, and if treatments are unavailable or under-resourced, the buck will stop with us; we'll be convenient scapegoats, we'll get the blame.

The doctor-patient relationship will be irrevocably changed, the bond irretrievably broken. We used to be Robin Hood, looking out for the little guy; now we'll be like the Sheriff of Nottingham, working for The Man, Minions of the Evil Consortium.

And minions don't get paid much.

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