New 'patient choice' policies take no account of limited resources and funding, say the authors. Patients - 'consumers' in the new NHS - bear no financial responsibility for the choices they make. Primary Care Trusts (PCTs), who pay for local health services in each area, are simply picking up the bill with no control on spending.

The Government's proposals for expanding market forces in the NHS will also be inefficient, say the authors. The aim is to drive costs down and improve quality through competition - external companies vying for NHS contracts. But prices have been fixed in advance, neutralizing the benefits of market forces.

In addition, more resources are going into the "black hole" of the hospital sector, and the way Foundation Trusts are funded heavily distorts the market.

Such a system will not be sustainable, say the authors: "We face the prospect of an NHS led totally by patients, with supply responding purely to consumer demand without any recognised cap on expenditure." If the Government does not change tack, this "can only lead to user charges," they warn.

Current UK policy seems based on US systems, say the authors. But these may not be transferable, particularly since organisations in the US deemed as successful models to follow, such as Kaiser Permanente, do not have to look after the range of health needs of a whole community, as the NHS does.

Instead the UK should introduce specifically-designed 'superpractices', family doctor surgeries expanded to include some hospital and social care services, all working together. Superpractices, servicing communities of 25-30,000 people and based on the old 'fundholding' model, would work best for controlling costs without compromising patient care, conclude the authors.

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Contact: Emma Dickinson
edickinson@bmj.com
44-207-383-6529
BMJ-British Medical Journal
1-Dec-2005