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Direct payments for NHS services could undermine equality, BMA warns


Plans to allow patients to pay directly for services could undermine equality in the NHS in England, create a new layer of bureaucracy, divert funding to unproven treatments, and result in some patients not getting the care they need, the BMA says today (Friday 22 January, 2010).

The Department of Health in England is currently exploring the possibility of personal health budgets. One option would be for some patients, for example those with long-term conditions, to hold their own budget and pay directly for NHS services.

In its response to a government consultation on direct payments, published today (Friday 22 January, 2010), the BMA raises concerns that:

o they would result in a new layer of bureaucracy and administrative burden on Primary Care Trusts (PCTs)

o they could result in an inequitable system that funds services or treatments for patients who hold a personal budget, but not for those who do not

o in the event that a patient’s budget is held by a third party, there would need to be safeguards to prevent exploitation

o a mechanism could be created to allow PCTs to refuse or ration further care to patients who had spent their whole budgets

o allowing patients to have money “banked” could encourage them to save it “for a rainy day” rather than spending what they need on their care

o the idea of healthcare simply as a commodity would be reinforced

Dr Hamish Meldrum, Chairman of Council at the BMA, says: “We believe in choice and flexibility for patients but these plans are worrying for a range of reasons. Apart from the practical difficulties and added bureaucracy involved, direct payments would take us even further towards a model where healthcare is a commodity to be bought and sold rather than something to which people are entitled. These proposals potentially undermine the principle of equal access on which the NHS is based.”


Notes to editors

View the full BMA response at:

The Department of Health consultation is at:


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