Your editorial of 16 March urges Andrew Lansley to rethink his plans for NHS reform because of the concerns expressed by the British Medical Association. While there are plenty of reasons to be sceptical about aspects of the current proposals, we need to understand that the BMA's arguments are based on protecting the interests of their members. Investment decisions in the NHS have often been distorted by the powerful lobbying of hospital doctors. As a result, London still has too many hospitals and hospital budgets have not been reduced anywhere in favour of investment in primary care, even where that would deliver more benefits to patients.
Of course hospital doctors are likely to oppose GP control and provider competition, as such changes will dramatically reduce their political influence on where the money goes, and will force them to compete on quality. Their argument that competition will inhibit collaboration to the detriment of patients would be a lot more convincing if the current NHS was not full of examples of failures of collaboration even inside individual hospitals.
So we should be careful to separate the necessary questioning of the reforms from the self-interested lobbying of the doctors' union.
Dr Stephen Black
PA Consulting Group
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