Abstract
Reynolds’s article on a better future for the NHS 1 provides an excellent analysis of the devastating and lasting negative effects of the 1990 NHS Reform Act on the cost and efficiency of the service and the standards of care provided.
However, one factor which does not receive sufficient attention is the impact of the contracts negotiated by the British Medical Association, first for general practitioners and then for consultants. The reduction in hours worked has inevitably had a serious effect on the productivity of the workforce with an increased cost for the NHS. More staff have had to be recruited to make up for lost hours and continuity of care has suffered both in general practice and in hospitals. In addition, the European Working Time Directive has reduced the time available for training junior doctors.
Finally, I want to endorse Reynolds’s comment on the need for rationing what a free NHS can provide for the public. This aspect still gets insufficient attention and the leadership of the profession should persuade the government to take responsibility for making the case for rationing, rather than undermining it, as illustrated in the article on the cancer drug fund published in the same issue of JRSM. 2