Last year the Archbishop of Canterbury attacked what he described as "the quiet resurgence of the seductive language of the deserving and undeserving poor".
The pressure to make huge savings within the NHS, coupled with the commissioning agenda and the introduction of private competition to that process could see the deserving and undeserving poor joined by the deserving and undeserving sick. This can't be right. After all, no one chooses to be sick.
When I hear insulting terms like "frequent flyers" being used to describe people who are sick and need our care and attention, I worry that the pressure to make savings and be the financial managers of care is compromising the relationship between clinician and patient.
We're already accused of making "inappropriate referrals" whenever we put what's best for our patients above what's best for saving money. But once we start sacrificing long-term benefits for the patient in favour of short-term savings we will lose the trust of our patients to do what is right for them.
The problem here is not placing GPs at the heart of commissioning, it’s allowing commissioning to compromise a GP’s responsibility towards their patients.
We mustn't allow ourselves to be compromised. Our first responsibility must be to the patient in front of us. Our next is to the patients in the waiting room. After that comes our responsibility to those on our list. And then to our local community, and finally the wider population. In that order.
People often tell me that GPs make good commissioners because of the population-focus we bring to care. First and foremost though, GPs must be allowed to be good GPs.
Part of that is understanding how we use resources fairly and effectively – or good commissioning.
But being a good GP is not about choosing between the best interests of our patients and those of the nation’s purse. Governments should have ultimate responsibility for decisions about rationing health care, not GPs – guided and advised by us, for sure, but finally the decision must be taken by a publicly accountable body, not an individual doctor or a group of doctors.
Of course, it's important that GPs are mindful of resources. We have a responsibility to spend the public's money carefully and wisely, but we must hold fast to the principle that good health care should be available to all.
I worry we're heading towards a situation where health care will be like a budget airline. There will be two queues: one queue for those who can afford to pay, and another for those who can't. Seats will be limited to those who muscle in first. And the rest will be left stranded on the tarmac.
But we shouldn’t allow the public to be deceived into believing that this will bring about the savings to the system that are being demanded.
If we are to make these savings in times of austerity, we need to do so as one NHS. Collaborating, co-operating and innovating – not competing against each other.
As long as we are allowed to do this, and more importantly what we know to be right for our patients, we will keep their trust.
Dr Clare Gerada spoke at the Nuffield Trust and The Royal College of Surgeons debate: Could the NHS further restrict the services it provides to offer a core package of services for all patients?
Dr Clare Gerada is Chair of the Royal College of General Practitioners. Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors’ own.
Gerada C (2012) ‘Keeping patients' trust’. Nuffield Trust comment, 17 February 2012. https://www.nuffieldtrust.org.uk/news-item/keeping-patients-trust