I should dearly like to endorse these Principles and I believe that I do agree with most or all of the intentions that lie behind them. However I should like to make a number of points which I think need to be addressed if the BMA is to give clear leadership on these issues. Failure to do this devalues our case and provides hostages to those who would undermine it. I write from the point of view of a general practitioner.
• Comprehensive health care requires definition and agreement between patients, public, politicians and health care providers. I am strongly in favour of but it will require a renewed commitment and a change of attitude within the profession.
• There needs to be clarity about the meaning of public provision. It seems hard to justify the independent contractor status within that term. I do believe in the independent contractor status but more thought needs to be given to the governance and accountability of independent contractors if they are to be included within any definition of public provision. It is otherwise hard to justify their profits as not being taken by shareholders.
• The concepts of cooperation and partnership with patients and the public need development and definition and, in particular, further debate on issues relating to the traditional distinction between ‘wants and needs’ which I think to be unhelpful . Similarly the meaning of the promotion of the care of patients before financial targets requires definition if it not to be meaningless.
• The commitment to training future generations of medical professionals needs to include clear policies that will provide satisfactory employment for them.
I hope the BMA will recognise the complexities of the provision of healthcare and the potential conflicts of interest. It should not resort to simplistic mantra of the type associated with the \’spin\’ of New Labour and, potentially, other political and interest groupings.