NHS commissioning is an ethical duty for GPs

GPs have an ethical obligation to lead NHS commissioning, according to a close vote in a debate at the RCGP conference on Thursday.

Dr Gillies (left) and Professor Marshall debated the ethical stance (Photograph: Peter Hill)

South London GP Professor Martin Marshall, RCGP ethics committee chairman, argued that GPs did have an ethical obligation.

Professor Marshall, who is also clinical director and director of research and development at The Health Foundation, said commissioning would better enable GPs to coordinate the care of patients who were ‘lost in the system’.

He added: ‘Unless we take this opportunity it will be our patients who suffer.’

Dr John Gillies, RCGP Scotland chairman, opposed him. He said: ‘Rationing and commissioning are the same things. A legal obligation doesn’t mean we have an ethical obligation to do this.’

A wide-ranging debate featuring many audience contributions included former health minister Baroness Julia Cumberlege who has been debating the Health Bill in the Lords.

Backing commissioning, she said: ‘Patients trust GPs. If decisions are to be made on my care I really want to have very strong clinical engagement at the
very top.

‘I think that’s the way to get much better decisions.’

A West Midlands GP, who also chairs his local clinical commissioning group, said GPs were better placed to make difficult clinical decisions if finances were tight. ‘We have to be more answerable to patients than we ever have been before. This gives us the opportunity to do that.’

Speaking against commissioning, north London GP Dr John Salinsky said: ‘Imagine you are a prisoner of war and the camp commandant says as a doctor you must make the decisions about who should be fed.

‘Doctors may think they have an ethical obligation to do their best or they may think they have an ethical obligation to refuse and instead concentrate on trying to escape.’

Delegates were also asked to vote on the Health Bill and almost everyone who took part in the session thought it should be rejected.

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